Objective To investigate the reversal effect on mdr1 gene mediated multidrug resistance in gastric cancer SGC7901/VCR cells by small interfering RNA(siRNA).Methods Two siRNAs(mdr1si2631 and mdr1si3071) specifically targeting mdr1 gene were designed and synthesized by transcription in vitro.The siRNA duplexes were used to transfect into the gastric cancer SGC7901/VCR cells.The expression levels of mdr1 mRNA and P-gp were detected by RT-PCR and immunohistochemistry respectively.The accumulation of intracellular adriamycin(ADR)was examined by flow cytometry and the cell sensitivity to ADR was demonstrated by MTT.Results The expression level of mdr1 mRNA treated by siRNAs for 48?hours was decreased in the SGC7901/VCR cells.The mdr1 RT-PCR product in the transfected mdr1si2631 SGC7901/VCR cells could hardly been found,similar to its parental SGC7901 cells,the ratio of mdr1 and ?-actin in the control SGC7901/VCR group was 1.05?0.10,the transfected mdr1si3071 group was 0.16?0.03(P0.05).The RT-PCR results showed that the mdr1 mRNA expression level in the mdr1 si2631 group decline more obviously than that in the mdr1si307l group,near by the level in its parental SGC7901 cells.The P-gp immunoreactivity(IR)in brownish-colored granules was located on the cell membrane.The P-gp IR became weaker in the SGC7901/VCR cells treated by siRNAs for 48 hours and the P-gp expression level in both transfected siRNA groups was decreased.The values of adriamycin-specific fluorescence intensity and the positive rates of intracellular ADR in both transfected siRNA groups were increased.The relative reversal efficiency of the SGC7901/VCR cells to ADR detected by MTT was 79.59%in mdr1 si2631 group and 59.98%in mdr1si3071 group respectively.Conclusion siRNA could reverse mdr1 gene mediated multidrug resistance in gastric cancer SGC790l/VCR cells.

Objective To investigate the clinical value of blood vessel diameter tracking and X-strain technology in evaluating the carotid elasticity in patients with diabetes.Methods Thirty-eight patients who were confirmed as diabetes without complications were enrolled in this study as the patient group and thirtyseven healthy volunteers matched with the patient group with sex,ages were typed as controls.The parameters reflecting common carotid elasticity:pulse wave velocity ( PWV),compliance coefficient (CC),stiffness index ( β),endovascular circumferential strain,strain rate,strain time ( EN _ CS,EN _ CS_ T,EN_CSR,EN_CSR_T),adventitial circumferential strain,strain rate,strain time (EP_CS,EP_CS_T,EP_CSR,EP_ CSR_ T),radial strain ( RS),radial strain rate (RSR) and radial strain time (RST) were measured using blood vessel diameter tracking technique and X-strain technique.Significant difference between the two groups and correlations among these variables were evaluated.Results In patient group,PWV and β were significantly higher than those of the control group,while variables like CC,EN_CS,EN_CSR,EP_CS,EP_CSR,RS and RSR were lower with P ＜0.05.All strain time prolonged in patient group ( P ＜0.05).No significant differences were observed in longitudinal strain index.Furthermore,CC was inversely related with PWV( r =- 0.872,P ＜0.001 ),and age,systolic pressure,β were positively related with PWV ( r =0.322,P =0.005; r =0.384,P =0.001; r =0.927,P ＜0.001) in patients group.Conclusions The stiffness and compliance indexes measured by blood vessel diameter tracking technique and the circumferential and radial strain index obtained by X-strain technique can reflect vessel elasticity change of patient with diabetes objectively.

Objective To investigate the effect of spleen spontaneous shunt on portal vein hemodynamics in patients with liver cirrhosis with Doppler ultrasound. Methods Eighty-seven patients were divided into chronic hepatitis group, liver cirrhosis group and control group. Liver function of cirrhosis patients was classified into Child A and Child B/C according to Child-Pugh categorization criteria. Hemodynamic parameters of hepatic artery, portal vein, superior mesenteric artery/vein and spleen artery/vein were examined on resting condition. Then the blood shunt ratio of spleen vein and superior mesenteric vein with portal vein, as well as hepatic circulation index (HCI) were calculated. The relationship between spleen blood shunt and HCI was analyzed. Results Portal vein blood flow was not significantly different among groups. Spleen vein blood flow increased in cirrhosis group, which was significantly different to that of control group and chronic hepatitis group. The spleen shunt ratio of cirrhosis group was greater than that of control group and chronic hepatitis group, as well as the Child B/C and Child A in cirrhosis group;the ratio of spleen vein flow to portal vein flow and spleen vein flow to superior mesenteric vein flow increased, but the ratio of superior mesenteric vein flow to portal vein flow decreased with the liver function decreased in cirrhosis group. There was non-linear negative correlation between HCI and the spleen shunt ratio. Conclusion Spleen spontaneous shunt and splenic hyperdynamic circulation play an important role in liver perfusion. Detecting Vspv/Vpv ratio with Doppler ultrasound in patients with liver cirrhosis is helpful in assessing liver function reserve.

Objective:To evaluate the cerebral blood flow circulation time (CCT) by contrast-enhanced ultrasound, and to explore the change rule of CCT in different degree of intracranial pressure, so as to provide a new method for non-invasive monitoring of intracranial pressure.Methods:Ten patients with hemorrhagic stroke or acute craniocerebral trauma with increased intracranial pressure were selected from Tangdu Hospital, the Air Force Military Medical University from January to December 2019. Contrast-enhanced ultrasound was performed when the invasive intracranial pressure (iICP) increased (>20 mmHg, iICP increased group) and decreased to normal (≤20 mmHg, iICP normal group), CCT was measured and analyzed. The differences of CCTs between different iICP groups were compared and the relationship between CCT and iICP was analyzed.Results:①The CCT on the lesion sides of the same patients in the iICP increased group was significantly longer than in the iICP normal group[(9.34±2.58)s vs (6.48±1.91)s, P=0.002]. ②When iICP was increased in patients with hemorrhagic stroke or acute craniocerebral trauma, the CCTs of the diseased side and the non-pathological side were not statistically significant [(9.34±2.58)s vs (9.01±3.22)s, P=0.809]. ③Pearson correlation analysis and Spearman rank correlation analysis showed that there were no correlations between patient′s breathing, heart rate, carbon dioxide partial pressure, body temperature, GCS score and CCT (all P>0.05). Age, mean arterial pressure and CCT were moderately correlated ( r=0.518, 0.463 and P=0.023, 0.046, respectively). ④Logistic regression analysis showed that CCT was an independent risk factor related to intracranial hypertension( OR=0.7, 95% CI=0.47-0.95, P=0.036). The area under ROC curve (AUC) predicted by logistic regression was 0.750(0.588~0.912). Conclusions:Contrast-enhanced ultrasound noninvasive assessment of CCT can reflect the intracranial pressure in patients with hemorrhagic stroke or acute traumatic brain injury, and CCT has a predictive value for intracranial hypertension. When the patient has limited conditions for invasive intracranial pressure monitoring, or when the invasive monitoring probe is pulled out but still needs to evaluate intracranial pressure, the change of CCT can provide an effective reference for clinical diagnosis and treatment.

Atherosclerosis is usually the underlying cause of cardiovascular diseases. With the change in diet structure and living environment, it has become an increasingly serious global health problem, posing a huge challenge to public health. Berberine, also known as flavonidol, is an isoquinoline-type quaternary alkaloid with purgative and detoxifying effects. Berberine and its derivatives have antibacterial, antiviral, anti-inflammatory, antioxidant, hypoglycemic, hypolipidemic, and atherosclerosis prevention effects, etc. Recent research results showed that berberine and its derivatives can play an important role in atherosclerosis prevention through a hypolipidemic effect, anti-oxidative stress and anti-inflammatory activity, improvement of vascular endothelial dysfunction, and regulation of intestinal microbiota. In this review paper, the research progress on the mechanism of action of berberine and its derivatives in the prevention of atherosclerosis was reviewed from the perspectives of a lipid-regulating effect, inhibition of oxidative stress and the inflammatory response, improvement of vascular endothelial dysfunction, and regulation of intestinal microbiota. The aim of this paper is to provide a theoretical basis for reducing the occurrence of atherosclerosis, improving the clinical symptoms of patients, and further developing berberine-based drugs.

Objective To investigate the clinical features of pneumocystis pneumonia (PCP) in patients with chronic kidney disease. Methods Clinial data of 21 cases of the primary and secondary kidney diseases complicated with PCP,excluding renal transplantation,were analyzed retrospectively. Results Twenty-one cases consisted of 6 cases of primary renal diseases and 15 eases of secondary renal diseases.Twenty patients (95.2%) were receiving immunesuppressive therapy at the PCP onset.Main manifestations were fever,progressive dyspnea,cough with no or seldom sputum.Twenty patients presented obvious hypoxemia and 12 of them were type I respiratory failure.X-ray and CT imaging of 20 patients revealed diffuse pulmonary interstitial shadows or ground glass opacities in both lungs.All the patients were treaed with trimethoprim-sulfamethoxazole.Eleven patients died accounting for 52.3%.Compared with the survivors,elder age (60.91±15.08 vs 44.50±14.83,P＜0.05),lower blood oxygen pressure at onset [(48.11±19.05)mm Hg vs (65.91±13.13)mm Hg,P＜0.01],higher percentage of respirator application and other secondary lung infection were found in dead patients.No PCP relapsed after average 16-month follow-up in the survival patients. Conclusions PCP is a severe complication with high mortality during immunosuppressive therapy in patients with chronic renal disease.Early diagnosis and proper treatment are important to improve prognosis.

ObjectiveTo investigate the effect of direct-acting antiviral (DAA) on the recurrence of hepatitis C virus (HCV)-related hepatocellular carcinoma (HCC) after curative treatment. MethodsPubMed, Web of Science, Cochrane Library, CNKI, CBM, Wanfang Data, and VIP were searched for the clinical studies of DAA and the recurrence of HCV-related HCC published up to April 2020. Stata 14.0 software was used to perform the meta-analysis. The Cochran Q test was used to evaluate heterogeneity between studies; the fixed effects model was used for non-heterogeneous data, and the random effects model was used for heterogeneous data. The Egger regression method or the Begg rank correlation method was used to evaluate the presence or absence of publication bias. ResultsA total of 10 articles (11 studies) were included in our study, among which 8 articles (9 studies) compared the effect of DAA versus the absence of anti-HCV therapy on the recurrence of HCC after curative treatment. There were 991 patients in DAA group and 808 patients in untreated group. The results of the meta-analysis showed that DAA reduced the recurrence rate of HCC after curative treatment in patients with HCV infection (hazard ratio ［HR］=0.42, 95% confidence interval ［CI］: 0.28?0.36, P＜0.001). Three articles compared the effect of DAA versus interferon for the treatment of hepatitis C on the recurrence of HCC after curative treatment, with 267 patients in DAA group and 212 in interferon group, and the results of the meta-analysis showed that DAA and interferon had a similar effect on the recurrence rate of HCV-related HCC (HR=0.85, 95% CI: 0.64-1.15, P=0.298). ConclusionBoth interferon and DAA can significantly reduce the recurrence risk of HCV-related HCC after curative treatment, with no significant difference between them.

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease with unknown etiology, and patients with poor response to ursodeoxycholic acid and obeticholic acid may eventually progress to liver cirrhosis and even liver failure. Liver transplantation is the only effective treatment method for PBC at present. This article elaborates on liver transplantation, survival time after liver transplantation, complications, recurrence of PBC after liver transplantation, and prospects and challenges of liver transplantation in patients with PBC, so as to provide a reference for clinical outcome and treatment after liver transplantation for PBC.

OBJECTIVE：To prepare chelerythrine nanoparticles（CHE-NPs），optimize their formulation ，and evaluate its drug release behavior in vitro and its inhibitory effect on melanoma. METHODS ：Using methoxy polyethylene glycol-poly （lactic-co- glycolic acid ）（mPEG-PLGA）as carrier ，CHE-NPs were prepared by the nano-precipitation method. HPLC method and dialysis bag method were used to determine entrapment efficiency and drug loading. The formulation of CHE-NPs was optimized by Box-Behnken response surface design using overall desirability （OD）of them as dependent variables ，CHE dosage ，mPEG-PLGA concentration and poloxamer 188（F68）concentration as independent variables. The particle size and Zeta potential of CHE-NPs prepared by the optimal formulation were detected ；the characteristics of drug release in vitro were investigated ；the effects of CHE and CHE-NPs on survival rate of mice B 16 melanoma cells were compared ，and median inhibition concentrations （IC50）of them were calculated. RESULTS ：The optimal formulation included CHE of 2 mg，mPEG-PLGA of 13 mg/mL，F68 of 1.8％. Average entrapment efficiency rate of CHE-NPs prepared by the optimal formulation was （80.18±1.11）％，average drug loading was （11.36±0.28）％，average OD value was 0.96±0.04 [the relative deviation from predicted value （0.90）of OD was 6.67％]； particle size was （113.1±1.40）nm，and Zeta potential was （－21.6±0.29）mV；polydispersity index was 0.07±0.01（n＝3）； accumulative release rates of CHE control and CHE-NPs were 90.87％ and 68.68％ within 8 h，and drug release behavior in vitro of the latter was in accordance with Weibull kinetic model. Inhibitory effect of CHE-NPs on B 16 melanoma cells was significantly stronger than that of CHE ；the 24 h IC 50 of CHE-NPs and CHEwere 69.35 and 107.36 μg/mL，respectively. CONCLUSIONS ：The prepared CHE-NPs show good sustained-effect and high capacity of drug loading ，and strengthen the inhibitory effect of CHE on melanoma.

Traumatic rib fractures are the most common injury in thoracic trauma. Previously，the patients with traumatic rib fractures were mostly treated non-surgically，of which 50%，especially those combined with flail chest presented chronic pain or chest wall deformities and over 30% had long-term disabilities，being unable to retain a full-time job. In the past two decades，thanks to the development of internal fixation material technology，the surgical treatment of rib fractures has achieved good outcomes. However，there are still some problems in clinical treatment，including inconsistency in surgical treatment and quality control in medical services. The current consensuses on the management of regional traumatic rib fractures published at home and abroad mainly focus on the guidance of the overall treatment decisions and plans，and relevant clinical guidelines abroad lacks progress in surgical treatment of rib fractures in recent years. Therefore，the Chinese Society of Traumatology affiliated to Chinese Medical Association and Chinese College of Trauma Surgeons affiliated to Chinese Medical Doctor Association，in conjunction with national multidisciplinary experts，formulate the Chinese Consensus for Surgical Treatment of Traumatic Rib Fractures（2021）following the principle of evidence-based medicine，scientific nature and practicality. This expert consensus puts forward some clear，applicable，and graded recommendations from aspects of preoperative imaging evaluation，surgical indications，timing of surgery，surgical methods，rib fracture sites for surgical fixation，internal fixation methods and material selections，treatment of combined injuries in rib fractures，in order to provide references for surgical treatment of traumatic rib fractures.