OBJECTIVE:To investigate the intervention effects of (E)-4-[2-(4-chlorophenoxy)-2-methylpropanoyloxy]-3-me-thoxyphenyl acrylic acid (AZ) on fat accumulation in human hepatoma HepG2 cells. METHODS:Oleic acid was used to induce fat accumulation in HepG2 cells in logarithmic phase for establishing models of fat accumulation,which were divided into a model group,a positive control group(100 μg/ml simvastatin),and the groups of 15.63,31.25,62.5,125,250,500 and 1 000 μg/ml AZ,and a normal control group was set up. MTT method was used to detect the survival rates of all groups of cells,kit was per-formed to determine the contents of triglyceride (TG) in all groups of cells and calculate the clearance rates,and oil red O stain was conducted to observe the lipid droplet morphology of all groups of cells. RESULTS:Compared to the normal control group, the model group and the groups of 15.63-125 μg/ml AZ demonstrated no obviously different survival rate of cells,and the groups of 250-1 000 μg/ml AZ had lower survival rate of cells. There was statistically significance (P<0.05). The contents of TG in the cells of the model group were higher than those in the cells of the normal control group. The positive control group and the groups of 62.5 and 125 μg/ml AZ had lower contents of TG in the cells compared to the model group,showing a TG clearance rate of (28.58 ± 0.15)%,(14.51 ± 0.09)% and (29.72 ± 0.16)% respectively. There was statistically significance (P<0.01 or P<0.05). There were much more lipid droplets in the cells of the model group than in those of the normal control group. The lipid droplets in AZ groups gradually became less in quantity and smaller with the increasing in drug concentration. CONCLUSIONS:AZ has inter-vention effect on fat accumulation in HepG2 cells.

Peroxisome proliferator-activated receptor α(PPARα)is an important subtype in the PPARs family. PPARs are a group of nuclear hormone receptors,which belong to type II nuclear receptor super family.PPARαagonists could be used in the treatment of hyperlipemia in clinic.PPARαagonists mainly include natural type and synthetic type,and according to the structure,the synthetic PPARαagonists can be divided into phenyl-heterocy-clic derivatives,ureide derivatives,amides derivatives,phenyloxazole or phenylthiazole derivatives,etc.So far, many PPARαagonists have been approved or in clinical development,and a series of novel PPARαagonists with higher activity and selectivity are being developed.This review will survey the progress in PPARαagonists.

Objective The expression and neuroprotective effect of meteorin in neurons and astrocytes after cerebral infarc-tion have yet to be clarified.This study was to investigate the expression and location of meteorin in the rat model of middle cerebral ar -tery occlusion (MCAO) and its neuroprotective effect against oxygen -glucose deprivation (OGD)-induced injury in cultured neurons or astrocytes. Methods Forty-two healthy adult male SD rats were randomly divided into 6 groups of equal number:sham operation and 6 h, 12 h, 24 h, 3 d, and 7 d MCAO.The cortical tissue was harvested for determination of the expression and location of meteorin by Western blot and immunohistochemistry as well as the meteorin expression in the neurons and astrocytes subjected to OGD. The neuroprotective effect of meteorin on the neurons and astrocytes was e-valuated by CCK8 and PI/Hoechst33342 staining. Results Com-pared with the sham operation group, the expression of meteorin was decreased after MCAO and reached the lowest level at 3 days ( P<0.01) , mainly in the neurons and astrocytes.Exogenous meteorin helped the survival of the astrocytes subjected to OGD, with the A value decreased in the groups of OGD ( 0.63 ) , OGD +meteorin
(0.78), and OGD+PBS (0.60) as compared with the sham control ( 1.51) (P<0.01), with no statistically significant differences among the former three groups (P>0.05).Concerning the effect of meteorin intervention on the OGD-induced injury of the astrocytes, the A value was significantly reduced in OGD (1.24 ±0.17), OGD+meteorin (1.51 ±0.30), and OGD+PBS (1.23 ±0.16) in comparison with the sham control (2.43 ±0.12) (P<0.01), lower in the OGD and OGD+PBS groups than in the OGD+meteorin group ( P<0.05) . Conclusion Meteorin is mainly expressed in the neurons and astrocytes after MCAO and it promotes the survival of the astrocytes with OGD-induced injury.

[Objective]To observe the clinical effect of"lung-intestinal treatment"method for adjuvant treatment of acute exacerbation of chronic obstructive pulmonary disease(AECOPD)mechanical ventilation patients with syndrome of lung heat and Fu-viscera excess.[Methods]Sixty-two patients with AECOPD in Pulmonary and Critical Care Medicine(PCCM)and Intensive Care Unit(ICU)of the Third Affiliated Hospital of Zhejiang Chinese Medical University were selected and divided into conventional treatment group and treatment group by random number table,31 cases in each group.The conventional treatment group was treated with western medicine,and the treatment group was added with lung-intestinal treatment on the basis of the conventional treatment group.The traditional Chinese medicine(TCM)syndrome points,blood gas index,ventilator parameters,mechanical ventilation time,complications and clinical effects were observed.[Results]Compared with before treatment,the conventional treatment group had improvement in the blood gas index,ventilator parameters,TCM syndrome(cough and asthma,sputum,abdominal distension and constipation,fever,chest tightness)and total points after treatment(P＜0.05);after treatment,the blood gas index,ventilator parameters,TCM syndrome(cough and asthma,sputum,abdominal distension and constipation,fever,chest tightness,loss of appetite)were relieved and total scores were all improved in the treatment group(P＜0.05).Compared with the conventional treatment group,the treatment group had significantly improved blood gas index,ventilator parameters and clinical effects,the TCM symptoms(chest tightness,cough and asthma,abdominal distension and constipation,loss of appetite)were relieved and total scores were improved(P＜0.05),and the time of mechanical ventilation and complications were reduced compared with the conventional treatment group(P＜0.05).[Conclusion]The treatment of AECOPD mechanical ventilation patients with"lung-intestinal treatment"method has clear cu rative effect,which can relieve clinical symptoms,shorten the time of mechanical ventilation,and the efficacy is better than that of western medicine alone.

Objective To explore the risk factors of aseptic meningitis (AM) after microvascular decompression (MVD) to provide evidence for preventing the occurrence of AM. Methods One hundred and forty-one patients diagnosed as having trigeminal neuralgia or hemifacial spasm, admitted to our hospital from January 2014 to December 2016, were chosen. A retrospective analysis was performed on these clinical data. Eighteen related factors of AM were analyzed by Logistic regression model. Results The result of single analysis of related factors showed that gender, age, diabetes, operation time, skill level of the operator, injection of dexamethasone, and postoperative dressing time were related to AM after MVD (P<0.05). Multifactor Logistic regression analysis showed that gender (OR=2.920, P=0.015), diabetes (OR=0.200, P=0.026), and non-injection of dexamethasone (OR=7.970, P=0.002) were independent risk factors of postoperative AM. Conclusion The male or diabetic patients have high rate of postoperative AM; and the risk of postoperative AM would be reduced if we inject dexamethasone to the cerebellopontine angle cistern at the end of MVD.

Objective:To investigate the clinical efficacy of full-endoscopic technique through the posterior cervical Delta large portal for the treatment of cervical spondylotic myelopathy and radiculopathy.Methods:The clinical data were analyzed retrospectively of the 15 patients who had been treated for cervical spondylotic myelopathy or radiculopathy at Orthopedics Department, Jiaxing Xiuzhou District People's Hospital from January 2020 to June 2021. There were 6 males and 9 females, aged from 54 to 76 years (average, 66.2 years). Responsible levels: 3 cases of C3, 4, 4 cases of C4, 5, 7 cases of C5, 6 and 1 case of C6, 7. They were all treated by full-endoscopic technique through the posterior cervical Delta large portal. The therapeutic efficacy was assessed by comparing the neck disability indexes (NDI) and Japanese Orthopaedic Association (JOA) cervical scores at preoperation, 1 and 3 months post-operation, and the last follow-up, and the modified MacNab scores at the last follow-up. The operative effects on cervical curvature and segmental stability were assessed by comparing the C2-7 cobb angles and operative ranges of motion (ROM) at preoperation, 1 and 3 months postoperation, and the last follow-up.Results:All cases completed their operation successfully. The operation time ranged from 56 to 82 min (average, 65.7 min), and the intraoperative blood loss from 10 to 30 mL (average, 20.7 mL). Tissue infection, intraspinal infection, dural tear, nerve root injury or perioperative anesthesia-related complications occurred in none of the patients. All patients were followed up for 6 to 18 months (average 10.8 months). The NDIs at 1 and 3 months post-operation, and the last follow-up (18.54%±3.06%, 14.96%±2.33%, and 12.89%±2.33%) were significantly lower than that before operation (34.19%±3.83%), and those at 3 months postoperation and the last follow-up significantly lower than that at 1 month postoperation ( P<0.05), but there was no significant difference between 3 months postoperation and the last follow-up in NDI ( P>0.05). The JOA scores at 1 and 3 months postoperation, and the last follow-up [(12.28±1.65), (13.30±1.57) and (13.54±1.41) points] were significantly higher than the preoperative value [(9.25±1.49) points] ( P<0.05), but there was no such a significant difference between postoperative time points ( P>0.05). Comparisons between preoperation, 1 and 3 months postoperation, and the last follow-up showed no significant difference in the C2-7 cobb angle or operative ROM ( P>0.05). The modified MacNab scores at the last follow-up resulted in 9 excellent, 5 good and 1 fair cases. Conclusion:In the treatment of cervical spondylotic myelopathy and radiculopathy, the full-endoscopic technique through the posterior cervical Delta large portal shows the advantages of limited invasion and complications, rapid recovery after operation, and little impact on the cervical curvature and segmental stability.

Objective:To study the regional distribution, temporal trend, and health inequity of burn incidence in the world from 1990 to 2019.Methods:The data related to burns worldwide from 1990 to 2019 were collected from the database of Global Burden of Disease (GBD). Based on the number of burn cases and age-standardized incidence rates, the incidence of burn was observed by age, region, socio-demographic index (SDI) area (divided into 5 categories of SDI areas: high, medium-high, medium, medium-low and low, the higher the area, the higher the degree of social development) and country, all of which were expressed as estimated values. Joinpoint regression analysis of the age-standardized incidence of burns from 1990 to 2019 was performed using Joinpoint 4.8.0.1 software to observe the average annual percentage change (AAPC). Rstudio software was used to analyze the Spearman correlation between the age-standardized incidence of burns and SDI from 1990 to 2019. The global inequities of burn incidence were evaluated using the slope index and concentration index from the health equity assessment toolkit, where the slope index reflected the absolute difference in burn incidence between countries with the lowest and highest SDI, and the concentration index indicated the degree to which burn incidence was concentrated in countries with low or high SDI.Results:From 1990 to 2019, the number of global burncases increased from 8 378 121.71 to 8 955 227.68, with an increase of 6.89%. However, the age-standardized incidence rate of burns showed an overall downward trend, from 149.86/100 000 in 1990 to 117.51/100 000 in 2019, with an AAPC of -0.80%. The incidence of burns in the population aged 10-19 years ranked the first in all age groups during the 30 years. Among the six regions of the world, the number of burn cases and the age-standardized incidence rate of burn in the Americas were the highest in 2019, but these two indexes were lower than those in 1999. In 2019, the number of burn patients in medium SDI areas was the highest, and the number of burn patients in low SDI areas was the lowest. The age-standardized incidence of burns was the highest in high SDI areas, and the lowest in medium-low SDI areas. From 1990 to 2019, the number of patients in high and medium-high SDI areas decreased, and the number of patients in other SDI areas increased. Compared with 1990, the age-standardized incidence rates of burns decreased in all SDI regions in 2019, with the greatest decline seen in high SDI and medium-high SDI regions. Cuba had the highest standardized incidence of burns, while Pakistan had the lowest. Spearman correlation analysis showed that from 1990 to 2019, the age-standardized incidence rates of burns in 204 countries and regions were positively correlated with SDI (all P<0.05), and the correlation coefficient decreased from 0.49 in 1990 to 0.37 in 2019. The health inequality slope index decreased from 212.90/100 000 in 1990 to 59.12/100 000 in 2019, and the concentration index decreased from 21.77% in 1990 to 8.38% in 2019. Conclusion:From 1990 to 2019, the global burn incidence rates are disproportionately concentrated in countries and regions with better development status. A significant reduction in the global burn incidence has been accompanied by a significant reduction in these inequities.

The adverse health effects of air pollution remains a daunting public health problem globally. The research of the health effects of air pollution provides important evidence for ambient air quality standard establishments and air pollution interventions. In recent years, causal inference has been gradually introduced into the observational study of environmental epidemiology, which provides more statistical method options for the study of causal relationships between air pollution and population health effects. Controlling confounders in observational studies is a major challenge for causal inference. This study introduces the causal inference methods for the identification and control of confounding factors currently used in the study of air pollution and population health effects, in order to provide methodological reference and basis for the causal inference study of air pollution and population health effects in China.

Objective:To introduce the health insurance fund supervision model in Japan,compare the current situation of health insurance fund supervision in China,learn from experiences,and propose suggestions for improvement.Methods:By combining cases and regulatory effects,it introduces Japan's"guidance-inspection"based health insurance fund supervision model.Results:Japan's"guidance-inspection"based health insurance fund supervision model is relatively effective.Compared with China,it has a higher level of organizational hierarchy,focuses on education in its supervisory approach,clarifies the direction of patients'self-paid expences,and has a well-developed dual-way communication mechanism.Conclusion:China should establish a comprehensive health insurance fund supervision pathway,clearly define the resolution pathway for self-paid expenses caused by violations,and improve the mechanisms for negotiation and dispute resolution during the process.

Objective:To introduce the health insurance fund supervision model in Japan,compare the current situation of health insurance fund supervision in China,learn from experiences,and propose suggestions for improvement.Methods:By combining cases and regulatory effects,it introduces Japan's"guidance-inspection"based health insurance fund supervision model.Results:Japan's"guidance-inspection"based health insurance fund supervision model is relatively effective.Compared with China,it has a higher level of organizational hierarchy,focuses on education in its supervisory approach,clarifies the direction of patients'self-paid expences,and has a well-developed dual-way communication mechanism.Conclusion:China should establish a comprehensive health insurance fund supervision pathway,clearly define the resolution pathway for self-paid expenses caused by violations,and improve the mechanisms for negotiation and dispute resolution during the process.