Objective:To explore the clinical efficacy of thermal moxibustion combined with Duhuo Jisheng Decoction in the treatment of liver and kidney deficiency syndrome of knee osteoarthritis (KOA).Methods:From January 2020 to January 2021, 124 KOA patients with liver and kidney deficiency syndrome, who met the inclusion criteria, were divided into 2 groups according to the random number table method, with 62 in each group. The control group was treated with Duhuo Jisheng Decoction, and the observation group was treated with thermal moxibustion on the basis of the control group. Both groups were treated for 28 days. TCM symptom scores were performed before and after treatment, the Osteoarthritis Index of Western Ontario and McMaster University (WOMAC) was used to evaluate joint function. ELISA was used to detect serum insulin-like growth factor-1 (IGF-1), fibroblast growth factor-2 (FGF-2), transforming growth factor-β1 (TGF-β1), IL-1β, IL-6, TNF-α levels, and the clinical efficacy was evaluated.Results:The total effective rate was 91.9% (57/62) in the observation group and 77.4% (48/62) in the control group, and there was significant difference between two groups ( χ2=5.04, P=0.025). After treatment, the TCM symptom score and WOMAC score of the observation group were significantly lower than those of the control group ( t values were 11.33 and 12.23, respectively, all Ps<0.01). After treatment, the serum levels of IGF-1 [(15.63±2.03) ng/L vs. (12.78±1.57) ng/L, t=8.75], FGF-2 [(30.26±5.37) ng/L vs. (26.31±1.94) ng/L, t=5.45] and TGF-β1[(30.39±6.71)μg/L vs. (24.31±5.12) μg/L, t=5.67] in the observation group were significantly higher than those in the control group ( P<0.01), while the levels of IL-1β [(12.50±3.36) ng/L vs. (16.09±4.90) ng/L, t=4.76], IL-6 [(10.59±3.28) ng/L vs. (21.75 ± 4.09) ng/L, t=16.76] and TNF-α [(4.04±1.92) ng/L vs. (6.48±1.43) ng/L, t=8.03] in the observation group were significantly lower than those in the control group ( P<0.01). There was no adverse events from both groups during treatment. Conclusion:Thermal moxibustion combined with Duhuo Jisheng Ddecoction can alleviate the joint pain of KOA patients with liver and kidney deficiency syndrome, promote cartilage repair and improve the clinical curative effect.

Objective:To verify the clinical safety and efficacy of new intelligent ventilation mode adaptive minute ventilation (AMV)+IntelliCycle ventilation in patients with mild-to-moderate acute respiratory distress syndrome (ARDS).Methods:The patients with mild-to-moderate ARDS, admitted to intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from February 2018 to February 2019, were enrolled in the study. The patients were divided into synchronous intermittent mandatory ventilation+pressure support ventilation (SIMV+PSV) group and AMV+IntelliCycle group according to the random number table method. All patients were given mechanical ventilation, anti-infection, analgesia and sedation, nutritional support and symptomatic treatment of primary disease after admission. SV800 ventilator was used for mechanical ventilation. In the AMV+IntelliCycle group, after setting the minute ventilation volume (VE), inhaled oxygen concentration (FiO 2) and positive end expiratory pressure (PEEP), the ventilator was turned on the full-automatic mode, and the preset value of VE percentage was 120%. In the SIMV+PSV group, the ventilator parameters were set as follows: the ventilation frequency was 12-20 times/min, the inspiratory expiratory ratio was 1∶1-2, the peak inspiratory pressure (PIP) limit level was 35-45 cmH 2O (1 cmH 2O = 0.098 kPa), and the setting of FiO 2 and PEEP was as the same as that of AMV+IntelliCycle group, the triggering flow was set to 2 L/min. All of the clinical parameters between the two groups were compared. The main outcomes were duration of mechanical ventilation, ventilator alarm times, manual operation times, and the mechanical power; the secondary outcomes were respiratory rate (RR), VE, tidal volume (VT), PIP, mouth occlusion pressure (P0.1), static compliance (Cst), work of breathing (WOB), and time constant at 0, 6, 12, 24, 48, 72, and 120 hours; and the blood gas analysis parameters of patients before and after ventilation were recorded. Results:A total of 92 patients with mild-to-moderate ARDS were admitted during the study period, excluding those who quit the study due to death, abandonment of treatment, accidental extubation of tracheal intubation and so on. Eighty patients were finally enrolled in the analysis, with 40 patients in SIMV+PSV group and AMV+IntelliCycle group respectively. ① Results of main outcomes: compared with the SIMV+PSV mode, AMV+IntelliCycle ventilation mode could shorten the duration of mechanical ventilation (hours: 106.35±55.03 vs. 136.50±73.78), reduce ventilator alarm times (times: 10.35±5.87 vs. 13.93±6.87) and the manual operations times (times: 4.25±2.01 vs. 6.83±3.75), and decrease the mechanical power (J/min: 12.88±4.67 vs. 16.35±5.04, all P < 0.05). But the arterial partial pressure of carbon dioxide (PaCO 2) of AMV+IntelliCycle group was significantly higher than that of SIMV+PSV group [mmHg (1 mmHg = 0.133 kPa): 41.58±6.81 vs. 38.45±5.77, P < 0.05]. ② Results of secondary outcomes: the RR of both groups was improved significantly with the prolongation of ventilation time which showed a time effect ( F = 4.131, P = 0.005). Moreover, compared with SIMV+PSV mode, AMV+IntelliCycle mode could maintain a better level of RR, with intervention effect ( F = 5.008, P = 0.031), but no interaction effect was found ( F = 2.489, P = 0.055). There was no significant difference in VE, PIP, P0.1 or Cst between the two groups, without intervention effect ( F values were 3.343, 2.047, 0.496, 1.456, respectively, all P > 0.05), but they were significantly improved with the prolongation of ventilation time in both groups, with time effect ( F values were 2.923, 12.870, 23.120, 7.851, respectively, all P < 0.05), but no interaction effect was found ( F values were 1.571, 1.291, 0.300, 0.354, respectively, all P > 0.05). The VT, WOB or time constant in both groups showed no significant changes with the prolongation of ventilation time, and no significant difference was found between the two groups, there was neither time effect ( F values were 0.613, 1.049, 2.087, respectively, all P > 0.05) nor intervention effect ( F values were 1.459, 0.514, 0.923, respectively, all P > 0.05). Conclusion:AMV+IntelliCycle ventilation mode can shorten the ventilation time of patients with mild-to-moderate ARDS, reduce mechanical power, and reduce the workload of medical care, but PaCO 2 in the patients with AMV+IntelliCycle mode is higher than that in the patients with SIMV+PSV mode.

Objective To investigate the anatomy characteristics of saphenous artery(SA) and its perforator vessels in mini pig,and to provide a new perforator flap animal model.Methods Between May,2018 and August,2018,6 7-months-old mini pigs weight 25 kilograms were sacrificed by blooding under general anesthesia.The bilateral external iliac arteries were injected with a mixture of latex-lead oxide mixture and underwent CT-scanning to provide 3-dimensional reconstruction.The origin,diameter,courses and distribution of the SA and perforators of both hind limbs were observed.Results One of the hind limbs was abandoned due to the leakage of perfusion fluid.The other 11 hind limbs were available.The femoral artery passed through the medial femoral muscle and sartorius muscle in the middle of thigh,and run between the medial femoral muscle and gracilis muscle above the knee.Below the knee,it run on the surface of the medial leg muscles.A number of small branches were distributed in the tarsal joint and calcaneus at the medial malleolus,and there were abundant communicating branches with the posterior tibial artery.The average length of SA was (14.86±0.76) mm.The outer diameters of SA at initiative,medial tibial condyle and medial malleolus were(1.73±0.15) mm,(1.50±0.12) mm and (1.30±0.13) mm,respectively.There were a total of 79 perforators which were identified,with a mean of (7.09±1.16) perforators per hind limbs.And the average outer diameter was 0.10-0.78 (0.40±0.13) mm.Conclusion The SA constantly exist with good outer diameter.The number of perforator is abundant.SA can be used as a reliable animal model for studying and training of perforator flap.

Mood disorders/psychosis have been associated with dysfunctions in the default mode network (DMN). However, the relative contributions of DMN regions to state and trait disturbances in pediatric bipolar disorder (PBD) remain unclear. The aim of this study was to investigate the possible mechanisms of PBD through brain imaging and explore the influence of psychotic symptoms on functional alterations in PBD patients. Twenty-nine psychotic and 26 non-psychotic PBD patients, as well as 19 age- and sex-matched healthy controls underwent a resting-state functional MRI scan and the data were analyzed by independent component analysis. The DMN component from the fMRI data was extracted for each participant. Spearman's rank correlation analysis was performed between aberrant connectivity and clinical measurements. The results demonstrated that psychotic PBD was characterized by aberrant DMN connectivity in the anterior cingulate cortex/medial prefrontal cortex, bilateral caudate nucleus, bilateral angular gyri, and left middle temporal gyrus, while non-psychotic PBD was not, suggesting further impairment with the development of psychosis. In summary, we demonstrated unique impairment in DMN functional connectivity in the psychotic PBD group. These specific neuroanatomical abnormalities may shed light on the underlying pathophysiology and presentation of PBD.

BACKGROUND:In the earliest stages of embryonic development and organ formation, fibroblast growth factor family members function as mediating the growth, differentiation, survival, and morphology of progenitor cels. Fibroblast growth factor mediates metabolic function, tissue repair and regeneration in mature tissues by reactivation of signal pathways.
OBJECTIVE:To summarize and explore the role of the fibroblast growth factor signaling pathway in tissues and organs.
METHODS:A computer-based online search was conducted in CNKI and PubMed databases by using the key words of “fibroblast growth factor, signaling pathway” from 2010 to 2016 and 2000 to 2016, respectively to screen the relevant literatures. The language was limited to both Chinese and English. Research progress in the fibroblast growth factor signaling pathway was summarized.
RESULTS AND CONCLUSION:A total of 47 literatures were included. Mammalian fibroblast growth factor family is composed of 18 secreted signal proteins which interact with 4 tyrosine kinase signal fibroblast growth factor receptors. Interaction of fibroblast growth factor ligand with the receptor is regulated by a protein or cofactor binding proteoglycans and extracelular proteins. Activation of fibroblast growth factor receptor mediates interaction with cytoplasmic adapter protein, RAS-MAPK, and PI3K-AKT, phospholipase Cγand STAT signaling pathway by phosphorylation on a specific tyrosine residue. Four structuraly related intracelular non-signaling fibroblast growth factors regulate the voltage-gated sodium ion channels by their interactions. Fibroblast growth factors exist in almost al tissues and organs, and developmental defects and abnormal activity of this pathway (destruction of organogenesis) is associated with damage response to injury, metabolic disorders and cancer.

Objective To compare the safety of dopamine ( DA) and norepinephrine ( NE) in hypovolemic shock , and the impact on the stability of blood pressure and haemodynamics .Methods Eighty two patients with hypovolemic shock were given fluid resuscitation . All the patients were divided into two groups including DA group (n=41) and NE group(n=41).Recovery of blood pressure, hemody-namic parameters were observed at different time point , and the complications and mortality of two groups were recorded .Results Blood pressure of all the patients returned to normal in 15min after the medication, and became stable after 30min.There was no significant difference in the blood pressure in both groups except that of 15min.Compared with T0, There were higher in the numerous of CVP , CI, ELWI, ITBI.The ELWL at T2 in DA group was higher than that of NE group , while there was no significant difference in the other time points between the two groups(P>0.05).After treatment for 24 h, blood oxygen saturation, urine volume in two groups were significantly increased, blood lactic acid markedly reduced , but lactic acid in NE group was obviously lower than that in DA group (P<0.05).Com-pared with DA group, the incidence of arrhythmia cordis , 2-week mortality in NE group were significantly reduced (P<0.05), while the acute kidney injury in two group was not statistically different (P>0.05).Conclusion The effect of NE and DA in maintaining the stability of blood pressure and hemodynamic are equivalent , and NE did not increase the risk of acute kidney injury , but can effectively improve tissue perfusion , reduce arrhythmia and case fatality rate , improve clinical outcomes .

Objective To investigate the effect of Hydroxychloroquine plus Leflunomide on the lipid profile and disease activity index in patients with rheumatoid arthritis (RA).Methods A total of 140 elderly patients with RA who met the American College of Rheumatology (ACR) criteria were treated with Hydroxychloroquine (Group A,n =70) or leflunomide combined with hydroxychloroquine (Group B,n=70),and 100 healthy volunteers were selected as controls.The lipid profile was compared between the patient groups and control group.Lipid levels,Disease Activity Score 28 (DAS28),erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before treatment and 6 months after treatment between Group A and Group B.Results Compared with the control group,RA patients exhibited higher levels of total cholesterol (TC,P＜0.05),low-density lipoprotein cholesterol (LDL-C,P＜0.05) and triglycerides (TG,P＜0.01),and lower levels of high-density lipoprotein cholesterol (HDL-C,P＜0.05).After 6 months of treatment,the disease activity index (DAS28,P＜0.01),the duration of morning stiffness (P＜0.01),ESR,CRP,swollen joint count (SJC) and tender joint count (TJC) decreased in RA patients,compared with controls (P＜0.01 or 0.05).HDL-C levels increased and LDL-C levels decreased in Groups A and B after treatment,compared with pretreatment (P＜0.05 for all).After treatment,TC levels decreased in Group B,compared with Group A (P＜ 0.05),while TG levels had no significant difference between the two groups (P＞0.05).TC and LDL-C levels,ESR,CRP,DAS28,SJC and TJC were lower in Group B than in Group A (all P＜0.05).Conclusions Hydroxychloroquine in combination with Leflunomide therapy can not only control inflammation but also improve the lipid profile,and is more effective than single-drug therapy.The combination may reduce the risk of atherosclerosis and cardiovascular events in patients with RA.

ObjectiveTo study the effect on humoral immunity with combination of CsA and IL-2 fusion protein. MethodsForty C57/B6 mice were evenly divided into four groups,after receiving skin graft from DBA mouse.Mice in the experimental group was given CsA(30 mg/kg,ip) plus IL-2/Fc (1μg,ip) while the control group was only given CsA,each group was given HBV vaccine after skin graft surgery (2 μg,im),while blank group was only given vaccine after skin transplantation.The fourth group were left intact.Fourteen days later,the level of HBSAb,IL-4,IL-10,IFN-γ,IL-2 were measured with ELISA and IL-21and FoxP3 expression level and Tfh percentage of mixed lymphocytes detected. ResultsThe HBSAb level in experimental group is significantly higher than that in the control group and the survival time of skin graft is longer than that in the control group ( F =29.886,P =0.010 ; F =29.772,P =0.011).IL-2,IFN-γ are significantly higher than that in the control group( F =18.156,P =0.0020;F =90.042,P =0.003 ),but the Th2 cytokines such as IL-4,IL-10 are lower ( F =42.102,P =0.009 ; F =23.734,P =0.015 ).The expression level of both IL-21and FoxP3 are significantly higher than control group( F =9.784,P =0.048 ;F =27.883,P =0.012). ConclusionsCombination of CsA and IL-2 fusion protein can significantly enhance the immunogenicity of HBV vaccine and prolong graft survival time.It may be related to the higher expression level of IL-21and FoxP3.

ObjectiveTo purify and characterize the monoclonal antibody (McAb) against Chlamydia trachomatis pORF5 plasmid protein.Methods The hybridoma cells stably secreting specific McAb against pORF5 were cultured in a large scale,and protein G purification by affinity chromatography was used to purify 2H4 McAb.ELISA was used to determine the antibody titer,and identify McAb isotype.Immunofluorescence assay (IFA) and Western blot were performed to detect McAb specificity.Results The purity of 2H4 antibody was 93％,the titer reached 1:1024,and 2H4 McAb was identified to belong to IgG2a isotype,2H4 McAb reacted strongly with the GST-pORF5 fusion protein and endogenous pORF5 protein expressed by Chlamydia trachomatis serovar A,D,L2,Chlamydia muridarum ( MoPn ),Chlamydia psittaci 6BC,but not other chlamydial plasmid proteins and Chlamydia pneumoniae(Cpn) AR39 strain.Conclusion2H4 McAb against pORF5 protein was successfully purified with a high titer and specificity which lay a foundation for further study on pORF5 protein structure and function.

Objective To discuss the value of digital tomosynthesis for detection of pulmonary nodules. Methods Thirty patients suspected of having pulmonary nodules underwent chest radiography, digital tomosynthesis and CT examination. Above image data were transferred to postprocessing work station and were reviewed by 2 radiologists with 3 years of chest-radiology diagnosis experience in a double-blind method. The number, location and size of nodules were recorded. Then, 2 radiologists reviewed the all images once more, and discuss in consensus. The sensitivities of chest radiography and digital tomosynthesis for detection of pulmonary nodules were respectively calculated according to the CT results. Chi-square test was used for radiography, digital tomosynthesis and CT examination. Results Of 30 patients, 21 were detected having pulmonary nodules by X-ray radiography and 9 were negative, the total number of 40 nodules was detected, while 89 nodules in 26 patients were detected by digital tomosynthesis, and only 4 patients were negative. CT demonstrated 102 nodules in 27 patients, and 3 patients were negative. Taking CT as "gold standard", the sensitivities of X-ray radiography and digital tomosynthesis were 27.4%(28/102)and 87.2%(89/102), X~2=4.35, P<0.05, respectively. Conclusion Digital tomosynthesis has a high sensitivity for detection of pulmonary nodules compared with X-ray radiography, and could be an excellent and necessary supplementary technique of X-ray radiography.