Objective To evaluate the efficacy of Xuebijing injection plus oral acitretin for the treatment of erythrodermic psoriasis.Methods Forty-eight patients with erythrodermic psoriasis were equally and randomly divided into two groups by a random number table:test group treated with Xuebijing injection once a day plus oral acitretin,and control group treated with oral acitretin.The dose of acitretin began at 0.5 mg per kilogram per day,and was modified according to the tolerance in and response of patients.After 8 weeks of treatment,clinical efficacy was evaluated by psoriasis area and severity index (PASI) score,response rate and recurrence rate.Adverse reactions were also recorded and evaluated.Results The difference in PASI score between pre-and post-treatment was significantly higher in the test group than in the control group (34.9 ± 2.2 vs.27.3 ± 1.7,t =3.37,P ＜ 0.05).The total response rate was 87.5％ in the test group and 62.5％ in the control group (x2 =4.87,P ＜ 0.05).There was a statistical decrease in the average onset time ((13.5 ± 2.4) d vs.(20.7 ± 3.1) d,t =3.67,P ＜ 0.05),daily dose and total dose of acitretin ((26.4 ± 3.3) mg vs.(34.7 ± 3.5) mg,(1854.5 ± 85.2) mg vs.(2768.8 ± 88.7) mg,t =3.07,4.32,respectively,both P ＜ 0.05) in the test group compared with the control group.The recurrence rate was 9.5％ (2/21) in the test group and 26.6％ (4/15) in the control group (x2 =5.23,P ＜ 0.05).Conclusion In the case of erythroderma psoriaticum,Xuebijing injection combined with oral acitretin is superior to oral acitretin alone in clinical efficacy,onset time and reducing recurrence.

Objective To learn the medical experience of inpatients at public hospitals in Henan and the influencing factors.Methods Inpatient experience questionnaire (IPEQ) was customized for a random sampling of 500 inpatients at five tertiary public hospitals in Henan.Results Overall satisfaction of inpatients experience scored 8.48,of which the satisfaction for technical competence was the highest (4.19)and that for emotional support the lowest(3.31).The correlation analysis revealed that the doctors' technical competence score the highest correlation with the experiences (0.652).Conclusion Overall satisfaction of inpatients experience at public hospitals in Henan was found high in general,but humanistic care and service flow at the hospitals require further improvement.

Objective:To investigate the effect of Xidi Liangxue recipe on the proliferation and apoptosis of HaCaT cells through the long non-coding RNA (lncRNA) nuclear-enriched abundant transcript 1 (NEAT1) /microRNA (miR) -485-5p/signal transducer and activator of transcription 3 (STAT3) regulatory network. Methods:HaCaT cells were induced by interleukin-17 (IL-17), and the mRNA and protein expression of lncRNA NEAT1, miR-485-5p and STAT3 was detected in IL-17-induced HaCaT cells and normal human epidermal keratinocytes (NHEK) by quantitative PCR (qPCR) and Western blot analysis, respectively. The location of lncRNA NEAT1 and miR-485-5p in IL-17-induced HaCaT cells was observed by fluorescence in situ hybridization (FISH), and the targeted regulatory relationship among lncRNA NEAT1, miR-485-5p and STAT3 was verified by double-luciferase reporter gene assay. Chinese herbs were decocted according to the Xidi Liangxue recipe, SD rats were divided into two groups to be gavaged with the above decoctions (medicated group) or physiological saline (control group) for 5 days, and then serum samples were collected from the above two groups of rats separately. The IL-17-induced HaCaT cells were divided into 4 groups: control group treated with the control sera, lncRNA-NEAT1 overexpression group transfected with lncRNA-NEAT1 overexpression vectors and treated with the control sera, Xidi Liangxue recipe group treated with the medicated sera, and Xidi Liangxue recipe + lncRNA-NEAT1 overexpression group transfected with lncRNA-NEAT1 overexpression vectors and treated with the medicated sera. qPCR, Western blot analysis, flow cytometry, and cell counting kit (CCK8) assay were performed to determine the mRNA and protein expression of lncRNA NEAT1, miR-485-5p and STAT3, and to evaluate cell proliferation and apoptosis. The two independent samples t-test was used for comparisons between two groups, one-way analysis of variance for comparisons among multiple groups, and least significant difference (LSD) t-test for multiple comparisons. Results:The IL-17-induced HaCaT cell group showed significantly increased relative expression levels of lncRNA NEAT1 and STAT3 mRNA (1.84 ± 0.21, 2.20 ± 0.24, respectively) and significantly increased protein expression of STAT3 and p-STAT3 (1.27 ± 0.13, 2.43 ± 0.16, respectively), but significantly decreased expression level of miR-485-5p (0.32 ± 0.04) compared with the NHEK group (lncRNA NEAT1 and STAT3 mRNA: 1.00 ± 0.11, 1.00 ± 0.11, respectively, both P < 0.05; STAT3 and p-STAT3 protein: 1.00 ± 0.11, 1.00 ± 0.10, t = 2.54, 3.02, respectively, both P < 0.05; miR-485-5p: 1.00 ± 0.12, t = 2.94, P = 0.015). FISH demonstrated that miR-485-5p and lncRNA NEAT1 were co-located in the cytoplasm of HaCaT cells. The double-luciferase reporter gene assay showed that the relative activity of luciferase was significantly lower in the miR-485-5p group than in the negative control group (both P < 0.05) after the transfection with wild-type lncRNA NEAT1 or STAT3 recombinant plasmids, while there were no significant differences between the miR-485-5p group and negative control group after the transfection with mutant lncRNA NEAT1 or STAT3 recombinant plasmids (both P > 0.05). Compared with the control group, the lncRNA-NEAT1 overexpression group showed significantly increased expression of lncRNA NEAT1 and STAT3 (including STAT3 mRNA, STAT3 protein, and p-STAT3 protein) in HaCaT cells (all P < 0.05), but significantly decreased miR-485-5p expression ( P < 0.05) ; the Xidi Liangxue recipe group showed significantly decreased expression of lncRNA NEAT1 and STAT3 (all P < 0.05), but significantly increased miR-485-5p expression compared with the control group ( P < 0.05) ; significantly decreased expression of lncRNA NEAT1 and STAT3, but significantly increased miR-485-5p expression was observed in the Xidi Liangxue recipe + lncRNA-NEAT1 overexpression group compared with the lncRNA-NEAT1 overexpression group (all P < 0.05). After 24-, 48-, and 72-hour intervention, CCK8 assay showed that the proliferative activity of HaCaT cells was significantly higher in the lncRNA-NEAT1 overexpression group than in the control group (all P < 0.05), as well as in the Xidi Liangxue recipe + lncRNA-NEAT1 overexpression group than in the Xidi Liangxue recipe group (all P < 0.05), and the cellular proliferative activity was significantly lower in the Xidi Liangxue recipe + lncRNA-NEAT1 overexpression group and Xidi Liangxue recipe group than in the control group (all P < 0.05). The apoptosis rate was significantly lower in the lncRNA-NEAT1 overexpression group (5.84% ± 0.28%) than in the control group (14.75% ± 0.83%, LSD- t = 3.48, P = 0.002), but significantly higher in the Xidi Liangxue recipe group (35.72% ± 3.62%) than in the control group (LSD- t = 5.34, P = 0.001) ; the Xidi Liangxue recipe + lncRNA-NEAT1 overexpression group showed significantly increased apoptosis rate (27.64% ± 2.82%) compared with the lncRNA-NEAT1 overexpression group (LSD- t = 9.06, P < 0.001) . Conclusion:The Xidi Liangxue recipe could inhibit the proliferation of IL-17-induced HaCaT cells and promote their apoptosis, which may be related to the intervention in the lncRNA NEAT1/miR-485-5p/STAT3 regulatory network.

BACKGROUNDTo detect the micrometastases status in peripheral blood and regional lymph nodes of lung cancer patients by reverse transcription-polymerase chain reaction (RT-PCR).

METHODSCK19 mRNA expression in peripheral blood and regional lymph nodes was detected in 78 patients with lung cancer, and 30 patients with pulmonary benign lesions and 10 healthy volunteers as controls by RT-PCR. Meanwhile, all lymph nodes were also examined by traditional pathological method.

RESULTSThe positive rate of CK19 mRNA expression was 38.5% in peripheral blood of lung cancer patients, and 6.7% in patients with pulmonary benign lesions (6.7%) (Chi-square=10.505,P=0.001). No positive CK19 mRNA expression was found in peripheral blood of 10 healthy volunteers. The positive rates of CK19 mRNA of lymph nodes were 36.9% and 0 in lung cancer patients and pulmonary benign disease patients respectively (Fisher's exact=0.014). In lung cancer group, the metastatic rate of lymph nodes was 17.9% by traditional pathological examination, which was much lower than that by RT-PCR (Chi-square=7.664, P=0.006).

CONCLUSIONSRT-PCR amplification of CK19 mRNA is an sensitive method to detect early haematogenous and regional lymph nodes dissemination of cancer cells for patients with lung cancer. This method may lead to an earlier diagnosis and treatment of patients with subclinical metastasis in circulation and regional lymph nodes.

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the prefrontal lobe on dysphagia and impaired cognition, and to explore the neural mechanisms involved.Methods:Twenty-eight patients with dysphagia and mild cognitive impairment were randomly divided into an iTBS group of 16 and a control group of 11. The iTBS group received 20 minutes of iTBS (2 seconds on and 8 seconds off) of the right dorsal lateral prefrontal cortex (DLPFC) once daily for 2 weeks, with the intensity at 80% of the resting movement threshold of the right abductor pollicis brevis, while the control group was given sham iTBS. Before and after the treatment, both groups′ cognitive functioning was evaluated using the Montreal Cognitive Assessment Scale (MoCA), a trial marking test, a digit span test and a Stroop color word test. Video-fluoroscopy was used to record oral transmission times (OTTs), hyoid bone anterior displacement and hyoid bone upward displacement during swallowing. Resting-state functional magnetic resonance imaging measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity in the patients′ brains.Results:Before the treatment there was no significant difference in the average indices of cognition or swallowing function between the 2 groups. Afterward the average MoCA score had increased significantly in both groups, with the improvement in the iTBS group significantly greater than that of the controls. Average OTT had shortened significantly in both groups, with significantly greater improvement in the iTBS group. The magnetic resonance imaging showed that after iTBS treatment, local excitation indicators and functional connections in several brain regions had changed. ALFF and ReHo in the right anterior cuneus had increased, ReHo in the left middle temporal gyrus, the orbital region of the left inferior frontal gyrus and the left middle cingulate gyrus had decreased, and functional connectivity in the right DLPFC, the bilateral cuneus and the right middle cingulate gyrus had increased.Conclusions:Two weeks of intermittent TBS of the right DLPFC can improve the swallowing and cognition of persons with dysphagia. Functional reorganization of brain networks may be one of the neural mechanisms involved.

Sepsis is currently the leading cause of death in the intensive care unit, and its survivors also experience long-term immunosuppression and high rates of recurrent infections. At present, the clinical treatment of sepsis is still based on antibiotics, intravenous rehydration, and vasopressors, and there is no targeted drug treatment. However, as the rate of antibiotic resistance continues to increase, immunotherapy is highly anticipated as a new treatment. Patients with sepsis are often accompanied by acute leukocyte immune dysfunction and immunosuppression, which may be an important risk factor for the increasing morbidity and mortality of patients. Targeted inhibition of specific cell surface inhibitory immune checkpoint receptors and ligands, such as programmed death receptor-1 (PD-1), programmed death-ligand 1 (PD-L1), and other targets, can improve the host’s resistance to infection. In this paper, the research progress of PD-1 and PD-L1 in the immune response to sepsis was summarized to provide a theoretical basis for their further application in the treatment of sepsis in the future.

Objective To determine the prevalence of dysphagia among elderly population and patients with stroke,head and neck cancer or neurodegenerative diseases in China.Methods Patients with stroke,head and neck cancer and neurodegenerative diseases,as well as elderly people older than 65 were selected.They were surveyed using the Sydney or Ohkuma swallowing questionnaire and evaluated using the Kubota's water swallow test and videofluoroscopic swallowing study (VFSS).The incidence of dysphagia among patients with the three diseases and elderly population was recorded,and its relationship with age,gender and economic status was also observed.Results For 7000 people surveyed,6102 met the inclusion criteria.Of all the included participants,2363 (38.7％) were identified as having swallowing abnormalities.Dysphagia was found in 46.3％ of stroke patients at the acute phase,56.9％ of stroke patients at the chronic phase,40.8％ of Alzheimer's disease patients,46.2％ of Parkinson's disease patients,12.5％ of multiple sclerosis patients,50.0％ of amyotrophic lateral sclerosis patients,36.6％ of nasopharyngeal cancer sufferers,58.4％ of laryngeal cancer sufferers.The prevalence of oropharyngeal dysphagia was 26.4％ and 13.9％ in nursing home-and community-dwelling elderly people.The average prevalence rate of deglutition disorder in the midland (55.0％) was significantly higher than the east coast (38.6％),still significantly higher than the western areas (32.5％) of China (x2=116.2,P＜0.001),representing 3 different economic development status.This study demonstrated that the prevalence of the male (40.0％) was higher than the female (36.3％).Moreover,the prevalence increased with age.Conclusion Dysphagia is of high prevalence among patients with stroke,head and neck cancers or neurodegenerative diseases,as well as the elderly in China.Its prevalence has significant correlations with age,gender and economic status.

Objective To investigate the role of next generation sequencing technology in the detection of pathogenic bacteria in synovial fluid of prosthetic joint infection.Methods Nine samples of synovial fluid specimens of prosthetic joint infection patients with positive microbial culture from October,1 2016 to April 1,2017 were collected.Each specimen (200 μl) was used for next generation sequencing.Total DNA was extracted from synovial fluid samples.The collected DNA samples were amplified by PCR in the V4 region of 16S rDNA gene.The amplified products were sequenced using the Illumina Miseq platform,2× 250 bp double-end sequencing strategy.The sequencing results were compared with the SILVA database to analyze the types of bacteria and relative abundance in the DNA samples.A total of 200 μl sterile double-distilled deionized water was used as control.Results Nine cases of microbial culture positive prosthetic joint infection synovial fluid DNA samples were sequenced by 16S rDNA amplicon sequencing and yielded 3 132 415 high-quality reads and 3 752 operational taxonomic units (OTU).At the level of bacteria,a total of 9 different bacterial gates were detected on 9 DNA samples.At the level of bacteria,34 different bacteria were detected by 16S rDNA amplicon sequencing.Each DNA sample was detected by 16S rDNA amplicon sequencing and the bacterial genus was identical to that of laboratory culture.16S rDNA amplicon sequencing detected more species of bacteria [6(3,9.5)] than bacterial cultures [(1.0(1.0,1.0)].There was statistically significant difference in the number of bacteria detected in the same specimen between the 16S rDNA amplicon sequencing and the laboratory culture (Z=2.533,P=0.011).Among them,the dominant bacterial population (highest abundance) detected by 16S rDNA amplicon sequencing in four DNA samples was consistent with the results of laboratory culture.Conclusion In the prosthetic joint infection,the 16S rDNA amplicon sequencing technology can accurately detect pathogens that are consistent with the laboratory culture,and can detect other bacteria outside the laboratory culture.This technology can provide the basis for clinical diagnosis and antibiotic selection.

Objective:To establish a fluorescent reporter human induced pluripotent stem cell line (hiPSCs) for monitoring the expression of visual system homeobox 2 ( VSX2). Methods:VSX2_small guide RNA (sgRNA) was inserted into vector PX459 to construct knockout plasmid, and the P2A-eGFP knock-in donor plasmid was conducted at the same time.The two plasmids were transfected into BC1-hiPSCs.Single cell clones were generated after treatment of puromycin.Correct insertion was confirmed by PCR and Sanger sequencing.The isogenicity of the parental and the reporter hiPSCs was confirmed by STR analysis and karyotyping.Pluripotency capacity of the reporter hiPSCs was analysed by reverse trascription PCR and immunofluorescence.Three-germ-layer formation experiment was carried out to analyse the multi-lineage differentiation ability of the reporter hiPSCs.The reporter hiPSCs were further differentiated to obtain three-dimension (3D) retinal organoids, and immunofluorescence was used to identify the co-localization of the enhanced green fluorescent protein (eGFP) and VSX2.Results:A VSX2 eGFP reporter hiPSC clone was successfully obtained by CRISPR/Cas9 technology, which was consistent with the parental hiPSCs (BC1-hiPSCs) in morphology, without any chromosomal aberrations or cell line cross-contamination.Reverse transcription PCR assay and immunofluorescence showed obvious positive expressions of iPSCs markers in BC1- VSX2 eGFP-iPSCs, including NANOG, OCT4, SOX2, DNMT3B and GDF3 mRNA as well as NANOG, OCT4, SSEA4 and TRA-1-60 protein.The α-fetoprotein (AFP), α-smooth muscle actin (α-SMA) and neuronal class Ⅲ β-tubulin (TUJ1) were expressed in endoderm, mesoderm and ectoderm, respeetively, derived from BC1- VSX2 eGFP-iPSCs, and eGFP and VSX2 were co-stained in the neural retinal layer of 3D retinal organoids derived from BC1- VSX2 eGFP-iPSCs by immunofluorescence. Conclusions:VSX2 fluorescent reporter hiPSCs is successfully generated, which can monitor the temporal and spatial expression changes of VSX2 protein in real time, providing a powerful tool for evaluation of retina development mechanism and cell therapy.

Objective:To evaluate the reliability and validity of the Chinese version of the Ohkuma questionnaire.Methods:The Ohkuma questionnaire was translated and revised, before it was used to investigate 70 elderly patients. Cronbach′s alpha coefficient, Cohen′s kappa coefficient and Pearson correlation were used to evaluate the scale′s internal reliability, sub-item retest reliability and total score retest reliability. KMO and Bartlett tests were used to evaluate the validity. The correlation between the Chinese version of the Ohkuma questionnaire and ratings from video fluoroscopy before and after treatment was used to evaluate the scale′s discrimination ability.Results:The Cronbach′s alpha of the Chinese version of Ohkuma questionnaire was 0.831, with 0.814 in the initial evaluation and 0.808 in a second evaluation. The Cohen′s kappas of the 15 sub-items ranged from 0.728 to 1.000. The Pearson correlation coefficient of the total score was 0.914. The scale′s KMO value was 0.701. A t-test of the Ohkuma scores before and after treatment showed a statistically significant difference.Conclusion:The revised Chinese Ohkuma questionnaire has good reliability, validity and discriminatory power. It can be used to screen for dysphagia among the elderly.