BACKGROUND: Ephedra, a Chinese medicine, is often used to treat obesity with relatively satisfying results recently. However, the effects of Ephedra on the perimenopausal and postmenopausal obese women remain unclear.OBJECTIVE: To observe the effects of oral Ephedra decoction on body mass and the levels of blood lipids, blood glucose and hormone in ovarietomized obese rats.DESIGN: A completely randomized and controlled experiment.SETTING: Institute of Physiology and Psychology, School of Basic Medical Sciences, Lanzhou University.MATERIALS: The experiment was performed in the Key Laboratory of Pre-clinical Study for New Drugs of Gansu Province and the Laboratory of Institute of Physiology and Psychology, School of Basic Medical Sciences,Lanzhou University from February 2006 to June 2006. Forty-four healthy female SD rats were randomly divided into four groups with 11 rats in each group, namely sham-operated group, ovariectomized group, estrogen replacement therapy group and Ephedra group.METHODS: ① After having been narcotized by cloraminone (110 mg/kg),rats were underwent a bilateral ovariectomy except those in the sham-operated group, which were also operated, but their ovaries were not cut off. ②Rats in the sham-operated group and ovariectomized group were subcutaneously injected with sesame oil (0.2 mL/each rat) every day postoperatively till the end of the experiment. ③ The rats in the estrogen replacement therapy group were given estradiol (1 mg/kg) by subcutaneous injection every day postoperatively till the end of the experiment. ④ The rats in the Ephedra group freely drank 1% water extracts from Ephedra postoperatively, later the concentration of Ephedra gradually increased to 8% on the sixth day, which lasted until the end of the experiment. ⑤ The food intake was monitored daily, and body mass was measured every ten days. ⑥ At the end of the experiment, all the rats were fasted for 12 hours and collected blood samples for the measurement of serum indexes. The body mass and body length were measured to calculate the Lee's index [(g)×103/body length (cm)] at the same time.MAIN OUTCOME MEASURES: ① Body mass and Lee's index at different time points in each group. ② Food intake at different time points in each group. ③ Levels of blood lipids and blood glucose in each group. ④Levels of estrogen, progesterone and insulin in each group.RESULTS: Forty-four rats all entered the analysis of results. ① Result of body mass and Lee's index at different time points: The body masses on the 20th, 30th, 40th and 50th days in the ovariectomized group were (256.4±14.3),(271.3±16.1), (276.4±12.7), (285.7±24.2) g, which were significantly higher than those in the sham-operated group [(226.5±11.5), (241.8±12.6),(243.1±13.5), (251.1±22.4) g, P ＜ 0.05-0.01], and the Lee's index in the ovariectomized group was greater than that in the sham-operated group(317.2±13.5, 280.4±11.2, P ＜ 0.01). The body masses on the 40th and 50th days in the estrogen replacement therapy group were (243.7±14.8) and(246.2±11.9) g, which were significantly lower than those in the ovariectomized group (P ＜ 0.05-0.01), and the Lee's index (289.9±13.5) was lower than that in the ovariectomized group (P ＜ 0.01). The body masses on the 40th and 50th days in the Ephedra group were (245.4 ±14.1) and(252.4±14.9) g, and the Lee's index was 294.4±11.0, which were all lower than those in the ovariectomized group (P ＜ 0.05). ② Result of Food in take at different time points: The food intakes on the 30th, 40th and 50th days in the Ephedra group were (17.8±2.4), (22.3±3.9), (26.1±3.5) g per day,which were decreased as compared with those in the ovariectomized group[(25.9±4.7), (28.5±5.3), (32.8±5.5) g per day, P ＜ 0.05]. ③ Levels of blood lipids and blood glucose: The levels of triglyceride, cholesterol and low density lipoprotein cholesterol (LDL-C) in the ovariectomized group were (1.73±0.32), (1.45±0.50), (0.78±0.19) mmol/L, which were higher than those in the sham-operated group [(0.94±0.29), (1.05±0.30), (0.08±0.11) mmol/L, P ＜ 0.01]. After the estrogen replacement therapy, the levels of triglyceride, cholesterol, LDL-C and blood glucose were (1.10±0.34),(1.14±0.30), (0.17±0.05), (5.88±1.21) mmol/L, which were lower than those in the ovariectomized group (P ＜ 0.05-0.01), but the level of high density lipoprotein cholesterol (HDL-C) was higher than that in the ovariectomized group [(1.11±0.31), (0.88±0.21) mmol/L, P ＜ 0.05]. The levels of triglyceride, cholesterol, LDL-C and HDL-C in the Ephedra group were (0.97±0.16), (1.11±0.20), (0.59±0.07) and (0.45±0.061) mmol/L, which were lower than those in the ovariectomized group (P ＜ 0.05-0.01). ④ The serum levels of estrogen, progesterone and insulin in each group: The serum levels of estrogen and progesterone in the ovariectomized group were lower than those in the sham-operated group [(17.09±9.00), (28.51 ±7.99) μg/L;(58.69±12.11), (62.73±10.93) μg/L, P ＜ 0.01], the serum level of insulin was higher than that in the sham-operated group [(31.74±6.69),(23.75±6.66) mU/L, P ＜ 0.01]. The serum levels of estrogen in the estro gen replacement therapy and Ephedra group were (36.03±8.83) and (30.18±8.61) ng/L, which were higher than those in the ovariectomized group(P ＜ 0.05-0.01), the level of insulin were (21.34±4.57), (24.86±6.20) mU/L,which were lower than those in the ovariectomized group (P ＜ 0.05-0.01).The serum level of progesterone in the Ephedra group [(17.68±6.19) μg/L]was lower than that in the ovariectomized group (P ＜ 0.01).CONCLUSION: Ephedra can promote loss of body mass, reduce levels of the blood lipids and insulin, and increase the serum levels of hormones in ovariectomized obese rats.

AIM To study the therapeutic effects of Neiyi Kangfu Tablets (Trionycis Carapax,Ostreae concha,Rhei Radix et Rhizoma,etc.) on adenomyosis and its possible mechanism of action.METHODS The mouse model for adenomyosis was set up by the pituitary allograft,and received the gavage of Neiyi Kangfu Tablets,Dan'e Fukang Decoction (Salviae miltiorrhizae Radix et Rhizoma,Curcumae Rhizoma,Paeoniae Radix rubra,etc.) and gestrinone,respectively,for three months.Western blot,real-time PCR,IHC were used to measure the expression of GPER-Ras-STAT3 in ectopic endometrium and entopic endometrium.RESULTS High doses of Neiyi Kangfu Tablets could significantly lower GPER protein and gene expression;down-regulate the Ras and STAT3 protein expression;reduce the lesion severity score of ectopic tissue morphology.Its curative effect was better than Dan'e Fukang Decoction and gestrinone.CONCLUSION Neiyi Kangfu Tablets may control the development of ectopic lesions by inhibiting the GPER-Ras-STAT3 pathway activity and weakening the production of estrogen.

Objective To investigate the clinical and radiological features of psoriatic arthritis,and to offer a basis to the formulation of diagnostic and classification criteria for psoriatic arthritis with high sensitivity and specificity.Methods A cross-sectionaI and retrospective study was performed to analyze the clinical and radiological features of 61 patients with confirmed diagnosis of psoriatic arthritis,along with the clinical onset features and evolution rules of the disease.These features were compared with the traditional criteria for psoriatic arthritis.Results These patients exhibited divelse clinical and radiological features.Of the five types of arthritis involved in the traditional criteria,distal interphalangeal arthritis was diagnosed in 38 patients,asymmetric pauciarthritis in 5 padents,symmetric polyarthritis in 33 patients,arthritis mutilans in 4 patients,ankylosing spondylitis in 12 patients,and they symptomatically overlapped each other.Other types of arthropathy,which were not included in the traditional criteria,were also observed in these patients.For example,undifferentiated spondyloarthropathy was diagnosed in 17(28%)patients,peripheral enthesitis in 19(31%)patients,and arthritis in privileged sites in 6(10%)patients(5 in temporomandibular joint and 1 in sternoclavicular joint).In the case of radiological profiles in the traditional criteria,pen cap-like abnormality due to bone absorption was noticed in 6 cases,sharpening of finger tips in 6 cases,bamboo-like syndesmophyte in 5 cases,sacroiliitis grade 3-4 in 8 cases.Other radiological manifestations which were beyond the traditional criteria but found in the patients included fluffy periostitis(n=19),hyperostosis with ill-defined edge(n=12),bone erosion(n=25),local and assymmetry syndesmophyte(n=8),sacroiliitis grade 2-3(n=8),etc.The clinical findings hinted that psoriatic arthritis had diverse onset features,and took on a progressive course.Conclusions Psoriatic arthritis displays a diverse clinical,radiological and onset feature as well as a complicated evolution.The traditional criteria only cover partial characters,and could not satisfy the need for early diagnosis and accurate classification of psoriatic arthritis,and there is an urgent demand for the formulation of a new diagnostic and classification criteria for this disease.

ObjectiveTo investigate the anxiety and its interrelated factors of elderly outpatients. MethodsZung self-rating anxiety scale was used to evaluate 971 elderly outpatients, the scores between different sex, age, degree of education, etc. were compared. ResultsThe scores may become significantly different with the patients' sex, age, degree of education, satisfaction in regards to medical service and recognition of the disease(P<0.05).ConclusionFactors such as sex, age, degree of education, satisfaction of medical service, etc, deeply affect the anxiety in elderly outpatients.

Objective To evaluate an effective and feasible quantitative evaluation table of traditional Chinese medicine (TCM) syndrome differentiation, and to observe the effect of combination of TCM syndrome differentiation and standard bundle therapy in patients with septic shock. Methods A prospective randomized controlled trial was conducted. The septic shock patients with acute deficiency syndrome admitted to department of critical care medicine of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 1st, 2016 to December 31st, 2017 were enrolled. The patients were randomly divided into control group and Shenfu group. The patients in both groups received early application of standardized bundle therapy; those in Shenfu group received 60 mL Shenfu injection infusion in addition for 7 days. The TCM syndrome score was evaluated by classification and scoring method of TCM symptoms. The circulation and tissue perfusion, severity of disease, organ function, inflammation response, adjuvant treatment and 28-day mortality were compared between the two groups. Results A total of 50 patients with septic shock were enrolled in the analysis, 25 in control group and 25 in Shenfu group. The markedly effective rate of TCM symptoms score in Shenfu group was significantly higher than that in control group [60.0% (15/25) vs. 16.0% (4/25), P < 0.01]. There was no significant difference in all parameters before treatment between the two groups. After treatment, the observation indexes of both groups were improved. Compared with control group, the mean arterial pressure (MAP) in Shenfu group increased more significantly [mmHg (1 mmHg = 0.133 kPa): 13.0 (2.5, 28.5) vs. 6.0 (0, 13.5)], the lactate (Lac) and procalcitonin (PCT) decreased more significantly [Lac (mmol/L): 0.8 (0.1, 3.7) vs. 0.5 (-0.6, 1.7), PCT (μg/L): 2.0 (0.7, 32.3) vs. 0 (-1.8, 3.8)], activated partial thromboplastin time (APTT) was shortened more significantly [s: 8.5 (0, 12.9) vs. 0 (-7.2, 10.0)], and interleukins (IL-2 receptor and IL-6) levels decreased more significantly [IL-2 receptor (ng/L):1 031.0 (533.0, 1 840.0) vs. 525.5 (186.0, 1 166.8), IL-6 (ng/L): 153.1 (21.4, 406.8) vs. 35.1 (16.3, 110.1)] with significant differences (all P < 0.05). There was no significant difference in the use time of vasoactive drugs, duration of mechanical ventilation, severity of the disease or 28-day mortality between the two groups. However, the use time of vasoactive drugs in Shenfu group was shorter than that in control group (days: 5.48±4.81 vs. 8.28±7.83), and the 28-day mortality was decreased [8.0% (2/25) vs. 20.0% (5/25)]. Conclusions TCM syndrome score is helpful to evaluate the effect of TCM syndrome differentiation and treatment, and it is effective and feasible in clinical application. Septic shock patients treated with TCM syndrome differentiation and treatment combined with standard bundle therapy were significantly improved in circulation, tissue perfusion, coagulation function and inflammation reaction.

Objective:To study the safety and treatment outcomes of portal vein embolization (PVE) combined with lenvatinib plus an anti-programmed death-1(PD-1) antibody to treat patients with initially unreasectable hepatocellular carcinoma (uHCC).Methods:This study retrospectively analyzed the data of six patients with uHCC who received first-line combined systemic therapy with lenvatinib plus an anti-PD-1 antibody, and then underwent pre-hepatectomy PVE at the Department of Liver Surgery at Zhongshan Hospital, Fudan University from May 2019 to November 2020. All enrolled patients were males, aged (54.6±6.2) (ranged 46 to 63) years. Tumor response and liver volume were evaluated by medical imagings once every 2 months (±2 weeks) and evaluated using the Response Evaluation Criteria in Solid Tumours (version 1.1). Patients were followed-up by outpatient interviews or by phone calls to record their survival and tumor outcome status.Results:Three of the six enrolled patients had Barcelona Clinic Liver Cancer stage A and three had stage B disease. One patient achieved a partial response and five patients had stable diseases. The mean ± s. d. future liver remnant (FLR) percentage was (29.0±8.9) % before PVE and the combination therapy, and was (41.3±10.8) % before the last evaluation for liver surgery ( t=10.79, P<0.001). Hepatectomy was carried out in five patients, and one patient who failed to develop significant FLR hypertrophy did not undergo hepatectomy. Grade B post-hepatectomy liver failure and major postoperative complications (i.e. pleural effusion requiring additional percutaneous drainage) occurred in one patient. After a median post-operative follow-up of 4.5 (range: 1.0-12.3) months, all five patients were alive and were tumor free. Conclusion:PVE followed by hepatectomy is feasible in a uHCC patients receiving systemic therapy with lenvatinib and an anti-PD-1 antibody.

ObjectiveBased on the conjoint analysis of transcriptome and metabolome， the key genes in the phenylpropanoid biosynthesis pathway of Lonicera macranthoides were explored， which provided a basis for further exploring the synthesis and regulation mechanism of phenylpropanoid compounds in "Xianglei" L. macranthoides. MethodsThe stem， leaves， and three flowering flowers of "Xianglei" L. macranthoides were selected as experimental materials to construct transcriptome and metabolome. The transcriptome and metabolomics were conjointly analyzed by the Kyoto Encyclopedia of Genes and Genomes （KEGG） database and weighted correlation network analysis （WGCNA）， and the key genes in the phenylpropanoid biosynthesis pathway of L. macranthoides were explored. ResultsIn this study， 77 differential phenylpropanoids and 315 differential genes were found. Through the joint analysis of transcription and metabolism， nine key differential metabolites and four key genes related to them were finally discovered. Among them， cinnamic acid， 5-O-caffeoylshikimic acid，sinapyl alcohol， and chlorogenic acid were higher in flowers， and the content of the iconic effective component， namely chlorogenic acid，decreased sharply during the withering period. Caffeic acid，ferulic acid， 5-hydroxyconiferaldehyde，p-coumaryl alcohol， and syringin were higher in leaves. These four key genes belong to the cinnamic alcohol dehydrogenase （CAD） family， 4-coumaric acid： Coenzyme A （4CL） family， hydroxycinnamyl transferase （HCT） family， and L-phenylalanine ammonlyase （PAL） family genes. ConclusionAmong the four key genes excavated from L. macranthoides， TRINITY_DN42767_c0_g6 is related to the synthesis of p-coumaryl alcohol and sinapyl alcohol. TRINITY_DN43525_c4_g1 uses caffeic acid，ferulic acid，and cinnamic acid as substrates to catalyze the next reaction. TRINITY_DN47958_c3_g4 correlates with the synthesis of 3-p-coumaroyl quinic acid and caffeoyl-CoA， and TRINITY_DN52595_c1_g2 correlates with cinnamic acid synthesis. These findings provide a basis for further exploring the synthesis and regulation mechanism of phenylpropanoids in "Xianglei" L. macranthoides.