This article introduced Professor WENG Li-li’s experience in treating acne. She held that the following four principles should be obeyed during the treatment course: determination of treatment based on syndrome differentiation, application of drugs based on essence of disease; stopping using clearing heat and detoxicating when it achieved therapeutic effect; resolving method was the main method for syndrome of intermingled phlegm and blood stasis; weighing the main and secondary of excess and deficiency.

Kidney plays an important role in maintaining the homeostasis as an important excretory and endocrine organ.The occurrence and development of kidney disease is closely associated with glomerular filtration barrier dysfunction and renal interstitial remodeling.Matrix metalloproteinase-9 (MMP-9),a major enzyme in the extracellular matrix (ECM),plays an important role in the process of kidney disease by regulating the ECM components and its interaction with cytokines.The paper reviews the pathophysiology of MMP-9 in glomerular filtration barrier dysfunction and renal fibrosis to provide a theoretical basis for clinical treatment of kidney disease.

Objective To evaluate the effect of dexmedetomidine pretreatment on activation of Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway during intestinal injury in rats undergoing liver transplantation.Methods Thirty-two pathogen-free healthy adult male Sprague-Dawley rats,weighing 220-250 g,aged 8-10 weeks,were divided into 4 groups (n =8 each) using a random number table:sham operation group (S group),liver transplantation group (LT group),dexmedetomidine pretreatment group (D group) and dexmedetomidine plus atipamezole (specific α2-adrenergic receptor antagonist) group (D+A group).The model of liver transplantation was established in LT,D and D+A groups except group S.In group D,dexmedetomidine 50 μg/kg was injected intraperitoneally at 30 min before skin incision.In group D+A,atipamzole 250 μg/kg was injected intraperitoneally at 5 min before administration of dexmedetomidine.At 6 h of reperfusion,blood samples were collected from the inferior vena cava for determination of serum concentrations of intestinal fatty acid binding protein (iFABP),lipopolysaccharide (LPS),tumor necrosis factor-alpha (TNF-ct) and high-mobility group box 1 protein (HMGB1).Intestinal specimens were then obtained for examination of the pathological changes of intestinal tissues (under light microscope) and for determination of the expression of activated caspase-3,phosphorylated JAK2 (p-JAK2),phosphorylated STAT1 (p-STAT1) and phosphorylated STAT3 (p-STAT3).Intestinal damage was assessed and scored.Wet/dry weight ratio (W/D ratio) was calculated.Results Compared with group S,the concentrations of iFABP,LPS,TNF-α and HMGB1 in serum,intestinal damage scores and W/D ratio were significantly increased,and the expression of activated caspase-3,p-JAK2,pSTATI and p-STAT3 in intestinal tissues was up-regulated in LT and D groups (P＜0.05).Compared with group LT,the concentrations of iFABP,LPS,TNF-cα and HMGB1 in serum,intestinal damage scores and W/D ratio were significantly decreased,and the expression of activated caspase-3,p-JAK2,p-STAT1 and p-STAT3 in intestinal tissues was down-regulated in group D (P＜0.05).Compared with group D,the concentrations of iFABP,LPS,TNF-cα and HMGB1 in serum,intestinal damage scores and W/D ratio were significantly increased,and the expression of activated caspase-3,p-JAK2,p-STAT1 and p-STAT3 in intestinal tissues was up-regulated in group D+A (P＜0.05).The pathological changes of intestinal tissues were significantly attenuated in group D as compared with group LT.Conclusion The mechanism by which dexmedetomidine pretreatment reduces intestinal injury may be related to inhibition of JAK/STAT signaling pathway activation in rats undergoing liver transplantation.

Objective To observe the effect of hypothermia in reperfusion stage on prognosis during adult liver transplantation.Methods Data of 107 patients (62 males, 45 females, aged 25～65 years, ASA physical status Ⅲ or Ⅳ) underwent adult liver transplantation from January 2015 to December 2016 in our hospital were retrospectively analyzed.The temperature at the time of anesthesia induction (T0), skin incision (T1), anhepatic phase immediately (T2), immediate reperfusion (T3), 5 min after reperfusion (T4), abdomen-closing (T5) and the end of surgery (T6) were recorded to observe the trend of overall temperature change.Patients were devided into normal temperature group (core temperature was≥35℃ or ＜35℃ but the duration was less than 5 min in reperfusion period) and hypothemia group (core body temperature was ＜35℃ and the duration was>5 min) to compare difference between the two groups of perioperative blood loss, urine volume, postoperative extubation time, ICU staying time and hospitalization time.The influence of hypothermia during the new liver phase (T4-T6) on prognosis and correlation between duration of hypothermia and blood loss, urine volume, postoperative extubation time, ICU staying time and hospitalization time were analyzed.Results This study found that during the perioperative adult liver transplantation, the body temperature showed a decreasing trend first (T0-T4) and then an increasing one (T4-T6).The body temperature droped to the lowest at T4, which was lower than the normal body temperarure.Compared with T0, the temperature decreased obviously at T2-T5 (P＜0.05);Compared to normal temperature group, the amount of bleeding was more and the extubation time was longer in hypothermia group (P＜0.05), and there was no significant difference in urine volume, ICU staying time and hospitalization time between the two groups.There were positive correlations between the time of hypothermia and bleeding, extubation time, ICU staying time and negative correlations with urine output, while no obvious relations with postoperative hospital staying time.Conclusion During the perioperative liver transplantation, hypothermia increased the blood loss and postoperative extubation time.The longer the hypothermia time is, the poorer the prognosis is.

Objective To evaluate the role of nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway in attenuation of ischemia injury by hydrogen-rich University of Wisconsin (HRUW) solution during cold storage of rat donor kidneys.Methods Forty healthy adult male Wistar rats,weighing 200-250 g,were divided into 4 groups (n =10 each) using a random number table:control group (group C),University of Wisconsin (UW) solution group (group UW),HRUW solution group (group HRUW) and Nrf2 inhibitor all-trans retinoic acid (ATRA) group (group ATRA).ATRA 7 mg/kg was intraperitioneally injected once a day for 2 consecutive days,kidneys were isolated and underwent cold storage at 8 h after the last administration,and kidneys were stored in HRUW solution for 48 h at 4 ℃C in group ATRA.In UW and HRUW groups,the equal volume of normal saline was intraperitioneally injected instead,and isolated kidneys were stored in UW solution and HRUW solution for 48 h at 4 ℃C,respectively.Kidney specimens were obtained for microscopic examination and for determination of tumor necrosis factoralpha (TNF-α),interleukin-lbeta (IL-1β3),high-mobility group box 1 protein (HMGB1),IL-10 and 8-iso-prostaglandin F2α (8-iso-PGF2α) contents (by enzyme-linked immunosorlbent assay),superoxide dismutase (SOD) and catalase (CAT) activities (using spectrophotometry),and expression of Nrf2,heme oxygenase-1 (HO-1),Bcl-2,Bax and caspase-3 in renal tissues (by using Western blot).The damage to the renal tubules was scored.Results Compared with group C,renal tubular damage scores were signifieantly increased,TNF-α,IL-1β,HMGB1 and 8-iso-PGF2α contents were increased,IL-10 contents were decreased,the expression of Nrf2 and HO-1 was up-regulated,SOD and CAT activities were decreased,the expression of Bcl-2 was down-regulated,and the expression of Bax and caspase-3 was upregulated in group UW (P＜0.05 or 0.01).Compared w,ith group UW,renal tubular damage scores were significantly decreased,TNF-α,IL-1β,HMGB1 and 8-iso-PGF2α contents were decreased,IL-10 contents were increased,the expression of Nrf2 and HO-1 was up-regulated,SOD and CAT activities were increased,the expression of Bcl-2 was up-regulated,and the expression of Bax and caspase-3 was down-regulated in group HRUW,and the expression of Nrf2 and Bcl-2 was up-regulated (P＜0.05),and no significant change was found in the other parameters in group ATRA (P＞0.05).Compared witb group HRUW,renal tubular damage seores were significantly increased,TNF-α,IL-1β,HMGB1 and 8-iso-PGF2α contents were increased,IL-10 contents were decreased,the expression of HO-1 and Bcl-2 was down-regulated,SOD and CAT activities were decreased,and the expression of Bax and caspase-3 was up-regulated in group ATRA.Conclusion HRUW solution reduces inflammatory responses,oxidative damage and cell apoptosis during cold storage of rat donor kidneys,and the mechanism by which HRUW solution attenuates ischemia injury is related to activation of Nrf2 signaling pathway.

Objective To observe the mental and motor development of children with biliary atresia before and after liver transplantation,and analyze the effect of liver transplantation on neurocognitive functions.Methods Fifty children with biliary atresia who experienced living related liver transplantation were selected from Jan.2016 to Dec.2016 in our hospital,with an average age of 5 to 12 months regardless of gender.All the children were assessed by Bayley Scale of Infant Development (BSID) one day before surgery,to obtain the mental and motor development conditions.The results were indicated with Mental Development Index (MDI) and Psychomotor Development Index (PDI).The levels of preoperative ammonia,bilirubin,albumin and white blood cells were recorded,and their relationship with preoperative neurocognitive development was analyzed.The development indexes were obtained at 2nd week,3rd week and 1st month after surgery by the same method,and the neurocognitive changes were analyzed in children before and after the surgery.The effects of postoperative biliary complications,secondary operations,pneumonia infection and other complications on the postoperative development indexes one month after surgery were assessed.Results The preoperative mental and motor development was both below the standard level in 50 infants with average MDI and PDI in middle and lower state.The correlation analysis among the levels of preoperative blood ammonia,bilirubin and albumin showed statistically significant on development index (P ＜ 0.05).The levels of blood ammonia and bilirubin were negatively correlated with development index,while albumin levels showed a positive correlation.As compared with one day before liver transplantation,MDI and PDI were decreased at 2nd week after operation;the MDI increased,and PDI had no significant change at 3rd week after operation.MDI and PDI were significantly higher at 1 st month after operation than preoperation.As compared with 2nd week after operation,PDI and MDI were significantly increased at 3rd week and 1st month after operation.Postoperative persistent pneumonia infection could affect children's MDI,and biliary complications could affect PDI (P＜0.05).Concision The mental and motor development conditions of children with biliary atresia were in medium/low level,and the levels of preoperative blood ammonia,bilirubin and albumin may have significant influence.Liver transplantation may obviously improve the patient's neurocognitive function.

Objective To evaluate the effect of dexmedetomidine on postoperative brain injury in pediatric patients undergoing living-related liver transplantation.Methods Forty American Society of Anesthesiologists physical status Ⅲ or Ⅳ pediatric patients of both sexes,aged 5-12 months,weighing 5-10 kg,were divided into dexmedetomidine group (group D,n =20) and control group (group C,n =20) using a random number table.After induction of anesthesia,dexmedetomidine was infused in a loading dose of 1 μg/kg for 10 min followed by a continuous infusion of 0.3 μg · kg-1 · h-1 in group D.The equal volume of normal saline was given instead in group C.Immediately before skin incision (T1),at 30 min of anhepatic phase (T2),at 1 h of neohepatic phase (T3),immediately after peritoneum closure (T4) and at 24 h after operation (T5),the blood samples were collected from the central vein to detect the concentrations of neuron-specific enolase (NSE) and S-100β protein in serum by enzyme-linked immunosorbent assay.Postoperative delirium was assessed at 1 day after surgery using Pediatric Anesthesia Emergence Delirium scale.At 1 day before surgery and 1 week after surgery,the Mental Development Index (MDI) and Psychomotor Development Index were recorded using Bayley Scale of Infant Development Ⅱ.Results The concentrations of serum NSE and S-100β protein were significantly higher at T2-5 than at T1 in the two groups (P＜0.05).Compared with group C,the concentrations of serum NSE and S-100β protein were significantly decreased at T2.5,and the Pediatric Anesthesia Emergence Delirium scale score and incidence of delirium were decreased after surgery in group D (P＜0.05).The MDI and Psychomotor Development Index were significantly lower at 1 week after surgery than at l day before surgery in the two groups (P＜0.05).The MDI was significantly higher at 1 week after surgery in group D than in group C (P＜ 0.05).Conclusion Dexmedetomidine can reduce postoperative brain injury in pediatric patients undergoing living-related liver transplantation.

Objective By analyzing the cesarean delivery rate (CDR) and the indications of cesarean section in Jiangsu Province from 2012 to 2014, to find the strategy to reduce CDR.Methods Data of 40 hospitals whose number of delivery was over 2 400 per year from the database of the Quality Control Center of Gynecology and Obstetrics of Jiangsu Province from 2012 to 2014 were selected.The cohort was divided into two groups, one was specialized hospital including 11 maternal and child health hospitals and the other included 29 general hospitals.After analyzing the current status of cesarean section of the whole province, the average CDR and the distribution of the first indications of cesarean section in two groups were compared using Chi-square test.Results The average CDRs at year 2012, 2013 and 2014 were 53.8％(96 347/178 970), 51.8％ (97 509/188 142) and 48.8％(106 323/217 877), which had a trend of decrease (x2=1 026.2, P ＜ 0.01).CDR without medical indications for each year were 15.7％ (28 098/178 970), 15.5％ (29 162/188 142) and 12.8％ (27 888/217 877).The rate had decreased apparently from both 2012 and 2013 to 2014 (x2=217.6, P ＜ 0.01;x2=341.3, P ＜ 0.01).The CDRs of specialized hospitals for year 2012, 2013 and 2014 were 51.2％ (45 496/ 88 916), 50.6％ (45 853/90 607) and 49％ (55 404/113 105), while the CDRs of general hospitals for each year were 56.6％(50 851/90 054), 53.0％(51 656/97 535) and 48.6％(50 919/104 772).Both showed significant decreasing trend (x2=105.8 and 1 215.7, both P ＜ 0.01).The average CDR of general hospitals was obviously higher than that of specialized hospitals in 2012 and 2013 (x2=505.6 and 104.3, both P ＜ 0.01).However, the difference disappeared in 2014 (x2=3.2, P ＞ 0.05).The three main first indications of cesarean section were associated and postoperative pregnancy complications, and no medical indications.Interestingly, from 2012 to 2014, the CDR for scarred uterus in specialized hospitals raised from 5.4％ to 20.3％, and that in general hospitals increased from 6.7％ to 21.6％, which became the first.Conclusions The average CDR in Jiangsu Province tends to decrease each year, so does the CDR without medical indications.The first indication of cesarean section is associated or postoperative pregnancy complications, while scarred uterus becomes the most common in cesarean section.

Objective To evaluate the effect of dexmedetomidine on kidney injury induced by liver ischemia-reperfusion (I/R) in rats.Methods Twenty-four healthy male Sprague-Dawley rats,weighing 220-250 g,aged 8-10 weeks,were randomly divided into 3 groups (n=8 each) using a random number table:sham operation group (group S);liver I/R group (group I/R);dexmedetomidine group (group D).In group I/R,liver I/R model was established by clamping the portal vein,hepatic artery,supra-and infra-hepatic vena cava for 40 min,followed by 6 h of reperfusion in anesthetized rats.In group D,dexmedetomidine 100 μg/kg was injected intraperitoneally at 30 min before skin incision.The equal volume of normal saline was given instead of dexmedetomidine in S and I/R groups.At 6 h of reperfusion,blood samples were collected from the infra-hepatic vena cava for determination of blood urea nitrogen (BUN) and creatinine (Cr) concentrations (by automatic biochemical analyzer) and tumor necrosis factor-alpha (TNFα) and interleukin-10 (IL-10) concentrations in serum (by enzyme-linked immunosorbent assay).After blood sampling,the rats were sacrificed,and kidneys were harvested for examination of histopathological changes (with light microscope) and for determination of malondialdehyde (MDA) content (using thiobarbituric acid method) and superoxide dismutase (SOD) activity (by xanthine oxidase method),expression of activated caspase-3 (by immuno-histochemistry),and apoptotic cells (using TUNEL).Apoptotic rate was calculated.Results Compared with group S,the serum BUN,Cr and TNF-α concentrations were significantly increased,the concentration of serum IL-10 was decreased,the MDA content and apoptotic rate were increased,the SOD activity was decreased,and the expression of activated caspase-3 was up-regulated in I/R and D groups (P＜0.05).Compared with group I/R,the serum BUN,Cr and TNF-α concentrations were significantly decreased,the concentration of serum IL-10 was increased,MDA content and apoptotic rate were increased,the SOD activity was decreased,the expression of activated caspase-3 was down-regulated (P＜0.05),and the histopathological changes of renal tissues were attenuated in group D.Conclusion Dexmedetomidine can reduce kidney injury induced by liver I/R in rats,and the mechanism is probably related to inhibition of inflammatory responses,lipid peroxidation and cell apoptosis.

Objective To evaluate the effect of propofol on Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway in the hippocampus of rats undergoing orthotopic liver transplantation.Methods Twenty-four healthy male Sprague-Dawley rats,aged 8-10 weeks,weighing 220-250 g,were randomly divided into 3 groups (n =8 each) using a random number table:sham operation group (group S);orthotopic liver transplantation group (group O);propofol group (group P).After the rats were anesthetized with chloral hydrate,the model of orthotopic liver transplantation was established according to the method described by Nozato et al.in O and P groups.In group P,30 min infusion of propofol was started at a rate of 20 mg · kg-1 · h-1 via the right femoral vein immediately after onset of reperfusion.At 6 h of reperfusion,blood samples were collected from the infrahepatic vena cava,and then the rats were sacrificed.The hippocampi were harvested for determination of malondialdehyde (MDA)and nitric oxide (NO) contents and superoxide dismutase (SOD) activity.The serum levels of S100β protein and neuron-specific enolase (NSE) were determined by enzyme-linked immunosorbent assay.The expression of JAK2,STAT3 and inducible nitric oxide synthase (iNOS) mRNA was detected by quantitative real-time polymerase chain reaction.The pathological changes of hippocampal tissues were examined under the light microscope,and the cell apoptosis was measured using TUNEL.The apoptotic index was calculated.Results Compared with group S,the serum levels of S100β protein and NSE were significantly increased,the contents of MDA and NO were significantly increased,the activity of SOD was significantly decreased,the expression of JAK2,STAT3 and iNOS mRNA was significantly up-regulated,the apoptotic index was significantly increased (P＜0.05),and the pathological changes of hippocampal tissues were significantly aggravated in the other groups.Compared with group O,the serum levels of S100β protein and NSE were significantly decreased,the contents of MDA and NO were significantly decreased,the activity of SOD was significantly increased,the expression of JAK2,STAT3 and iNOS mRNA was significantly downregulated,the apoptotic index was significantly decreased (P＜0.05),and the pathological changes of hippocampal tissues were significantly reduced in P group.Conclusion Propofol reduces injury to the hippocampus through blocking JAK2/STAT3 signaling pathway in the rats undergoing orthotopic liver transplantation.