Objective:To investigate the clinical efficacy and safety of entecavir combined with triple viable bifidobacterium capsules in the treatment of patients with cirrhosis induced by chronic hepatitis B.Methods:Totally 86 chronic hepatitis B patients with cirrhosis were randomly divided into the observation group and the control group with 43 ones in each.The control group was given entecavir treatment,and the observation group was treated with triple viable bifidobacterium capsules additionally.The treatment course was three months.The effect of treatment,changes of liver function(TBiL,AST,ALT,etc.),liver fibrosis level (HA,PCⅢ,LN,etc.)and adverse events were compared between the groups before and after the treatment.Results:The total effective rate of the observation group was higher than that of the control group (P<0.05);the levels of TBiL,AST and ALT decreased in both groups after the treatment (P<0.05),and those in the observation group were lower than those in the control group (P<0.05);the levels of HA,PC III and LN decreased in the two groups after the treatment (P<0.05),and those in the observation group were lower than those in the control group (P<0.05);there were no significant adverse drug reactions in both groups during the treatment course.Conclusion:Entecavir combined with triple viable bifidobacterium capsules in the treatment of patients with cirrhosis induced by chronic hepatitis B exhibits significant clinical efficacy,which can improve liver function and liver fibrosis with promising safety and without significant adverse reactions.

Objective To measure the effect of tetrandrineon (Tet) on inflammatory mediators and endogenous neural stem cell proliferation after spinal cord injury (SCI) in rats.Methods A total of 162 Wistar rats were separated into injury group,Tet group and sham operation group according to the random number table,with 54 rats per group.Allen' s method was used for induction of experimental SCI.Animals in Tet group were given Tet (22.5 mg/kg) through the tail vein at 30 min,24 h and 48 h postinjury.The same volume of normal saline was given to other two groups.Spinal cord tissue samples were taken from the rats after injury to measure levels of tumor necrosis factor (TNF)-α,interleukin (IL)-1 β and IL-10,and tissues were examined with HE staining and Nestin immunohistochemistry staining.Results Levels of TNF-α,IL-1 βand IL-10 in injury and Tet groups increased compared to these in sham operation group at 6 h,12 h,1 d,3 d,5 d and 1 week postinjury (P ＜ 0.05).At the same time point,level of IL-10 was higher in Tet group than in injury group,but inversely for TNF-α and IL-1 β (P ＜ 0.05).More Nestin-positive cells were present in injury and Tet groups than in sham operation group at 1 d,3 d,1 week,2 week,3 week and 4 week postinjury (P ＜ 0.05).Additionally,more Nestin-positive cells were found in Tet group than in injury group at 1 d,3 d,1 week,2 week and 3 week postinjury (P ＜ 0.05).Conclusion Tet is effective to relieve inflammatory reaction,increase neural stem cell number and promote neurological recovery after SCI.

Objective To evaluate the feasibility and safety of performing endoscopic retrograde cholangiopancreatography (ERCP) assisted by single-balloon enteroscopy (SBE) in patients with biliary obstruction after gastrointestinal reconstruction.Methods Clinical data about 7 cases of single-balloon enteroscopy assisted-ERCP (SBE-ERCP) were summarized including the completion of treatment,operation time,and complications for retrospective study.Results The papilla or anastomotic site was reached and therapeutic ERCP were performed successfully in 6 patients.The overall success rate was 85.7％ (6/7),and the mean operation time of SBE-ERCP was 42 min (ranging from 28 to 72 min).The afferent loop and papilla were failed to be confirmed in 1 patient.No complication such as perforation,pancreatitis or bleeding ocurred in all the 7 patients.Conclusion Single-balloon enteroscopy assisted-ERCP (SBE-ERCP) is feasible and relatively safe in postsurgical patients with gastrointestinal reconstruction.

Objective To discuss the effect of tetrandrine on endogenous neural stem cell proliferation and differentiation after spinal cord injury in rats. Methods 78 rats were randomly divided into 3 groups: control group(n=36), Tet-treated group(n=36), sham-operated group(n=6). Control group and Tet-treated group were adapted with Allen's combat modeling method. Rats in Tet group were injected Ted with a dosage 22.5 mg/kg in 30 minutes, 24 hours and 48 hours after ASCI, and the same dose of saline was injected into injured group as control .Samples were dissected from the spinal cord injury sites at 1 day, 3 days, 1 week, 2 weeks, 3 weeks, 4 weeks after ASCI, and tested by HE staining for morphology and by immunolfuorescence staining for the expression of BrdU and nestin. Results A little Nestin positive cells and BrdU positive cells were found in control group and Tet-treated group at 1 day after injury. A large number of positive cells were found in both groups at 1 week after injury and reached the peak which lasted for 2 weeks and then decreased gradually. The expression of Nestin positive cells and BrdU positive cells in control group and Tet-treated group were decreased significantly at 4 weeks after injury, but were still more than that in sham operation group. The number of Nestin positive cells and BrdU positive cells in Tet-treated group were more than that in control group at each time point after injury. The expression was higher in Tet-treated group than control group at 1 day, 3 days, 1 week, 2 weeks, 3 weeks after injury and had no difference at 4 weeks after injury. Conclusions Tetrandrine could increase the number of Nestin positive cells, BrdU positive cells and endogenous neural stem cells though improving the microenvironment, and it is beneficial for the recovery of spinal cord injury in rats.

Objective To evaluate endoscopic management of bile duct benign and malignant stenosis after cholecystectomy.Methods A retrospective analysis was made on 120 bile duct benign and malignant stenosis developed after cholecystectomy, ERCP diagnosis and treatment was evaluated.Results Of the 120 cases, there was bile duct stenosis in 79 cases (including 61 cases with common bile duct stones), papillary inflamnatory stenosis in 15 cases, diverticulum associated duodenal papillitis in 8 cases, malignant biliary stricture in 8 cases.Among these 120 cases there were hilar benign stenosis in 3 cases, 3 cases with hilar malignant tumor, 4 cases of chronic pancreatitis.Benign bile duct stricture was treated with plastic stent drainage, concomitant calculi by endoscopic stone extraction.Papillary stenosis and papillitis were managed by EST or EPBD, inoperable malignant biliary stenosis by mental stent placement.Conclusions After cholecystectomy biliary stenosis treated by ERCP and endoscopic therapy is miniinvasive helping control biliary infection when the diagnosis of benign stenosis of bile duct is established.

Objective To investigate the application value of ELISA for detecting the serum anti desmoglein (Dsg) 1 and Dsg 3 in the diagnosis and treatment of pemphigus .Methods Forty‐seven patients with pemphigus in our hospital from January to De‐cember 2014 were selected as the observation group and contemporaneous 52 patients with excluding pemphigus were selected as the control group .The Dsg antibodies were detected by using indirect immunofluorescence method and Dsg 1 and Dsg3 were deter‐mined by ELISA ;their correlation with pemphigus characteristics was analyzed .Results The sensitivity and specificity of ELISA for detecting anti‐Dsg antibodies were 95 .74% and 92 .31% respectively ,while which of IIF were 93 .62% and 86 .54% respective‐ly ,showing no statistically significant difference between the two test methods (P>0 .05) .In 30 cases of pemphigus vulgaris ,16 ca‐ses (16/30) were positive Dsg1 and Dsg 3 ,8 cases of pemphigus erythematosus and 5 cases pemphigus foliaceus were positive Dsg1 only ,and 2 cases of pemphigus vegetans were both positive Dsgl and Dsg3 .The Dsgl and Dsg3 titers of pemphigus vulgaris and pemphigus vegetans were 130 .85 ± 86 and 112 .30 ± 85 .05 ,respectively ,and the disease activity score was (5 .10 ± 1 .86) points ,the correlation coefficient(r)=0 .476(P=0 .008) ,r=0 .816(P=0 .001) ,respectively .The Dsgl titer of pemphigus erythematosus and pemphigus foliaceus were 142 .59 ± 78 .52 ,and the disease activity score was (2 .77 ± 0 .92) points(r=0 .800 ,P=0 .001) .Conclu‐sion ELISA for detecting Dsg1 and Dsg3 has high sensitivity and specificity ,and is conducive to the diagnosis of pemphigus and e‐valuation of disease severity .

Objective: To study the effect of miR-194-3p on the migration of keloid fibroblasts. Methods: Differentially expressed miRNA were screened by gene chip in 8 human keloid and normal tissues. The down regulated miR-194-3p was selected for study and its binding to RUNX2 was predicted by MiRDB, and verified by fluorescent reporter gene in human keloid fibroblasts (HKFs) and passage 3 keloid cells, respectively. The effect of miR-194-3p on the migration of fibroblasts was detected by transwell assay. Western blot and real-time PCR were used to analyze the effect of miR-194-3p on RUNX2 and MMP2 expression in HKFs. The results were analyzed by SPSS 19.0 software and compared by non-paired t test. P<0.05 was considered statistically significant. Results: There were abnormal expressions of miR-721, miR-21-3p, miR-382-3p, miR-194-3p, miR-3107-5p and miR-144-5p in keloid. miRDB software analysis showed that miR-194-3p and RUNX2 had targeted binding sites. Reporter gene experiments showed that miR-194-3p inhibited the activity of RUNX2 by about 50% compared with the control group (t=2.7764, P=0.0005). MiR-194-3p could significantly inhibit the expression of RUNX2 and MMP2, and inhibited the migration of keloid fibroblasts (t=2.7764, P<0.05). Conclusion MiR-194-3p may inhibit the migration of fibroblasts by inhibiting the activity of RUNX2 in keloid.

Objective:To evaluate endoscopic nasobiliary drainage (ENBD) combined with nasojejunal tube feeding for elderly patients with severe acute cholangitis.Methods:Data of 43 elderly patients with severe acute cholangitis, who received ENBD combined with nasojejunal tube feeding from January 1, 2016 to May 31, 2018 at Affiliated Hangzhou First People′s Hospital, Zhejiang University School of Medicine were retrospectively analyzed and were included in the observation group, and 43 other patients who received ENBD combined with conventional therapy in the same period were included in the control group with the matching principle of 1∶1. Liver function indices (ALT and AST), nutritional status (Hb, TP and ALB) and inflammation indices (WBC, NEU% and CRP) of the two groups before the operation, 3 days and 7 days of nutritional support after the operation were compared. Adverse reactions (abdominal distention and diarrhea), mortality, hospitalization time and expenses of the two groups were also compared.Results:There were no significant differences in gender composition, mean age, preoperative APACHE-Ⅱ score, NRS2002 score, liver function index, nutritional index, or inflammatory index between the observation group and the control group ( P>0.05). The baseline data of the two groups were comparable. After 3 days of nutritional support, ALT, AST, TP were 21.0 (15.0, 35.5) U/L, 26.0 (21.0, 36.5) U/L, and 64.2±5.2 g/L, respectively in the observation group, and 47.0 (29.5, 82.5) U/L ( P<0.05), 47.0 (29.0, 75.0) U/L ( P<0.05), and 60.5±6.4 g/L ( P<0.05), respectively in the control group. The levels of other indicators were not statistically different at this time point ( P>0.05). At 7 days postoperative nutritional support, ALT, AST, TP, ALB and CRP of the observation group were 22.0 (14.0, 31.5) U/L, 26.0 (20.5, 38.5) U/L, 67.6±5.4 g/L, 34.6±3.7 g/L, and 28.0 (18.5, 35.5) mg/L, respectively, and 43.0 (18.0, 59.5) U/L ( P<0.01), 34.0 (24.0, 60.5) U/L ( P=0.02), 64.5±5.7 g/L ( P=0.01), 31.5±7.0 g/L ( P=0.02), and 34.0 (24.0, 66.5) mg/L ( P<0.05) in the control group. There were no significant differences in the levels of other indicators between the two groups at this time point ( P>0.05). In the observation group, the incidence of diarrhea, abdominal distension, mortality, hospitalization time and hospitalization expenses were 32.6% (14/43), 30.2% (13/43), 9.3% (4/43), 16.0±7.0 days and 40±10 thousand yuan, respectively, and in the control group, the above indicators were 4.7% (2/43) ( P<0.05), 7.0% (3/43) ( P<0.05), 11.6% (5/43) ( P=0.72), 19.3±3.7 days ( P<0.05)) and 53±23 thousand yuan ( P<0.05), respectively. Conclusion:For elderly patients with severe acute cholangitis, enteral nutrition with ENBD can effectively improve the nutritional status, reduce inflammatory reaction, the impact on liver function, and hospital costs, and shorten the hospitalization time, which is suitable for further clinical application.

BACKGROUND:Inflammation and oxidative stress contribute to the barriers of regeneration in chronic wound.Oxymatrine has various biological activities,such as anti-oxidation,anti-inflammation and so on,which may have the potential effect of promoting wound healing. OBJECTIVE:To investigate the effect of oxymatrine on wound healing and the protective effect on H2O2-induced oxidative stress injury in human keratinoid cell line HaCaT cells. METHODS:(1)In vivo experiment:Hyaluronic acid methacryloyl hydrogels containing 0,0.05,0.1,0.2 g/L oxymatrine were prepared.A full-layer skin defect model with a diameter of 12 mm was made in the back of 75 diabetic mice and randomly divided into five groups for intervention,with 15 mice in each group.The wounds of the model group were bandaged and fixed.The wounds of the hydrogel group were covered with hyaluronic acid methacryloyl hydrogel.The wounds of the low-dose,moderate-dose and high-dose oxymatrine groups were covered with hyaluronic acid methacryloyl hydrogel containing 0.05,0.1,and 0.2 g/L oxymatrine,respectively,and then bandaged and fixed after light curing.Relevant indicators were detected within 14 days.(2)In vitro experiment:Human keratinocyte line HaCaT was divided into five groups.The normal group was cultured conventionally.H2O2 group and low-,moderate-and high-concentration oxymatrine groups were treated with H2O2 for 4 hours,and then the medium was replaced with medium containing 0,0.05,0.1,and 0.2 g/L oxymatrine,respectively,and the relevant indexes were detected after 24 hours of culture. RESULTS AND CONCLUSION:(1)In vivo experiment:Compared with the model group,the wound healing rate of mice in the hydrogel group had no significant change.The wound healing rate of mice in the low-,moderate-and high-dose oxymatrine group was increased at 7 and 14 days after treatment(P<0.05).Pathological observation of wound section 14 days after treatment showed that compared with the model group,the thickness of regenerated epidermal layer,the number of microvessels,and collagen deposition in the moderate-and high-dose oxymatrine groups were increased(P<0.05).Western blot assay analysis of wound samples 7 days after surgery showed that compared with the model group,the protein expressions of tumor necrosis factor α and interleukin 6 in the moderate-and high-dose oxymatrine groups were decreased(P<0.05).(2)In vitro experiment:CCK8 assay,EdU and Ki67 staining showed that compared with the H2O2 group,the cell proliferation ability of the moderate-and high-concentration oxymatrine groups was significantly increased(P<0.05).Compared with the H2O2 group,mitochondrial membrane potential was increased(P<0.05)and reactive oxygen species content was decreased(P<0.05)in the moderate-and high-concentration oxymatrine groups.Western blot assay results showed that compared with the H2O2 group,the expression levels of Nrf2 nuclear protein,Nrf2 total protein,HO-1 protein,and superoxide dismutase 1 protein were increased in the high-concentration oxymatrine group(P<0.05).(3)These findings confirm that oxymatrine can alleviate oxidative stress damage in HaCat cells and accelerate wound healing by upregulating the levels of Nrf2 and HO-1 protein.

Polycyclic aromatic hydrocarbons (PAHs) are widely found in the environment, and comparing to adults, children are more vulnerable to PAHs exposure. Urinary metabolites of PAHs are used as preferred biomarkers to estimate the PAHs exposure. Systematic review on the internal exposure level of children and adolescents is rare. We aimed to calculate the internal exposure levels of PAHs in children and adolescents and compare the levels of PAHs internal exposure in various children groups. We searched PubMed, OVID, Web of Science, EBSCO, ACS, and four Chinese databases, and all studies examining the urinary concentrations of PAHs in children and adolescent were identified. The total exposure level of 11 PAHs metabolites were pooled. Standard mean difference (SMD) and 95% confidence intervals (CIs) of PAHs urinary concentration were calculated and pooled by RevMan5.3 to compare the exposure levels of different children groups. We found that 1-OHPyr, 2-OHNap, 2-OHFlu, 3-OHPhe, and 4-OHPhe were five PAHs metabolites most commonly studied in existing studies in children, and their total exposure levels were 0.38 ± 0.98, 2.32 ± 4.83, 0.81 ± 1.54, 0.09 ± 0.14, 0.03 ± 0.10 μmol/mol creatinine, respectively. The meta-analysis showed that the levels of 1-OHPyr were higher in higher environmental exposure group (SMD = 0.21, 95% CI = 0.03~0.40), ETS exposure group (SMD = 0.31, 95% CI = 0.08~0.54), and 6~11 years group (SMD = 0.16, 95% CI = 0.09~0.24); the level of 2-OHNap (SMD = 0.27, 95% CI = 0.01~0.53) was higher in higher environmental exposure group; however, the levels of 3-OHPhe (SMD = - 0.34, 95% CI = - 0.57~- 0.12) and 4-OHPhe (SMD = - 0.48, 95% CI = - 0.69~- 0.28) were higher in lower environmental exposure group. The levels of 1-OHPyr (SMD = - 0.01, 95% CI = - 0.11~0.10) and 2-OHNap (SMD = 0.01, 95% CI = - 0.20~0.22) were not statistically different between boys and girls. In conclusions, we found that the internal diversity of PAHs existed in children and adolescents, and the level of 1-OHPyr in children and adolescents was in higher status compared with non-occupational people who do not smoke.