Objective To observe the influence of insulin resistance(IR) and isosorbide mononitrate(ISMN) on myocardial cellular apoptosis in spontaneously hypertensive rats (SHR) .Methods Forty male 14‐week old Wistar(W) rats and SHR(S) each were respectively or jointly fed with normal diet (ND) ,high fat and high glucose(HFHG) diet ,normal saline(NS)and ISMN by ga‐vage .Then they were randomly divided into the normal and NS group (normal W and normal S ) ,HFHG and NS group(HFHG W and HFHG S) ,normal and ISMN group(ISMN W and ISMN S) ,HFHG and ISMN group(HI W and HI S) ,with 10 rats in each group .After 12‐week feeding ,carotid arterial blood was collected for detecting blood glucose concentration and insulin level and cal‐culating insulin resistance index (HOMA‐IR);4 myocardial tissue samples were taken for respectively observing the morphology under microscope ,and detecting the NO level ,myocardial Bcl‐2 ,Bax gene and their protein expression levels in myocardial tissue . Results Myocardial NO level ,Bax gene mRNA and related protein levels in the HFHG and ISMN intervention groups were higher than those in the normal group ,while the bcl‐2 gene mRNA and related protein expression were on the contrary ;myocardial tissue NO level ,Bax gene mRNA and related protein expression in the S groups were increased compared with the corresponding W groups ,while the bcl‐2 gene mRNA and related protein expression were on the contrary ;in the HFHG W group ,the myocardial tis‐sue NO level had significantly positive correlation with HOMA‐IR ,and in the ISMN W group ,HOMA‐IR was positively correlated with the NO level in the myocardial tissue .Conclusion Myocardial cellular apoptosis of SHR is increased compared with Wistar rats ;both IR and ISMN can aggravate the apoptosis of SHR myocardial cells ,moreover IR has a mutual induction and reciprocal causation with ISMN .

Objective Toevaluatea modified Ziehl-Neelsen(Z-N) stain in the diagnosis of tuberculous meningitis. Methods Cerebrospinal fluid specimens from 35 patients were stained by using the modified Ziehl-Neelsen staining. Re-sults The positive rate was 94.29% in 35 patients with tuberculous meningitisand the intracellular acid-fast bacilli was detected in 53.40%of all specimens. One case was stained positive in 15 patients with non-tuberculous meningitis. Con-clusion The modified Ziehl-Neelsen stain not only significantly improves the detection rates of tuberculous meningitisbut alsois able to identify intracellular M.tuberculosisin cerebrospinal fluidspecimen.Thus, the modified Z-N stain can be a convenient tool for diagnosing tuberculous meningitis.

Objective:To investigate the relationship between serum procollagen Ⅲ amino terminal peptide (PIIINP), collagen I carboxyl terminal cross-linking peptide (CTXI), high-sensitivity C-reactive protein (hs-CRP) and cardiac magnetic resonance (CMR) T 1 mapping value in patients with lone atrial fibrillation (AF). Methods:Fifty-five patients with lone AF in Beijing Anzhen Hospital from July 2017 to June 2018 were prospectively enrolled. Another 20 healthy volunteers were examined at the same time to provide normal reference range. All patients completed PIIINP, CTXI, hs-CRP and CMR examination within one week. CMR examination including cine, pre-contrast T 1 mapping, and late gadolinium enhancement sequences. We used t test, Mann-Whitney U test or chi square test to compare the difference of the above indexes between AF patients and the control group. Spearman correlation analysis was used to determine the associations between left ventricular native T 1 value and blood biomarker in AF patients. Results:All the patients were paroxysmal AF with an average age of (48±10) years, of which 46 (83.6%) were male. The PIIINP, CTXI, hs-CRP, left ventricular native T 1 value of AF patients were 5.83 (3.52, 12.40) ng/ml, 4.63 (3.31, 6.82) μg/ml, 3.41 (1.72, 6.61) mg/L and (1 261±23) ms, respectively, which all significant higher than those in healthy subjects (all P<0.05). The native T 1 value of left ventricular myocardium was positively correlated with PIIINP ( r=0.492, P<0.05) and hs-CRP ( r=0.516, P<0.05), but not with CTXI ( r=0.021, P>0.05). Conclusions:The PIIINP, CTXI and hs-CRP increased in patients with lone AF, PIIINP and hs-CRP were correlated with elevated native T 1 value of left ventricular myocardium.

Glaucoma is rarely complicated by retinitis pigmentosa (RP). To provide clinical evidences for this rare situation, we report the concurrence of these two diseases in two children of a Chinese family. In the present two-child Chinese family without positive history, the older sister presented with bilateral sector RP and coexisting chronic angle-closure glaucoma, and the brother with bilateral whole RP but without coexisting glaucoma. Clinical evidences in concurrence of variants of RP and glaucoma because of possible different gene mutations from the same genetic background represent a rare situation, which may provide clues for future researches in molecular pathogenesis of these rare diseases.
Female ; Glaucoma ; diagnosis ; Humans ; Retinitis Pigmentosa ; diagnosis ; Young Adult

OBJECTIVETo explore the correlation between pathological characteristics of target organs and excess evil syndrome in IgA nephropathy.

METHODSData were collected in multicenter cooperation. Totally 266 IgA nephropathy patients were typed into exogenous wind-heat affection syndrome (49 cases), lower energizer damp-heat syndrome (100 cases), damp-phlegm syndrome (43 cases), and blood stasis syndrome (74 cases). Meanwhile, percutaneous renal biopsy was performed in all patients for Hass classification, Oxford classification, Katafuchi integral, and Jiang's classification methods. The correlation between excess evil syndrome and pathological index was analyzed.

RESULTSFour syndrome types were correlated with their Hass levels (r = 0. 341, P <0. 01). Affection of exogenous wind-heat syndrome was correlated with segmental proliferation of endothelial cells and damaged active lesions of segmental capillary loops. Lower-energizer damp-heat syndrome was associated with Hass III level, destroying active lesions of capillary loops, segmental proliferation of endothelial cells, glomerular segmental lesions, focal interstitial infiltration of inflammatory cells, focal interstitial fibrosis and tubular atrophy. Blood stasis syndrome was associated with Hass IV level, glomerular sclerosis, segmental glomerulosclerosis (S)/adhesion, mesangial hypercellularity (M), angiohyalinosis, multi-foci interstitial infiltration of inflammatory cells, multi-foci interstitial fibrosis and tubular atrophy. Phlegm-damp syndrome had higher proportions of Hass I and III levels, but with no association with other pathological parameters.

CONCLUSIONSExcess evil syndrome was associated with partial pathological characteristics of IgA nephropathy. It could reflect pathological damage degree of target organs, activities, chronic lesions, and prognosis of IgA nephropathy to certain extent. Correlated pathological characteristics and its evolution could indicate excess evil syndrome types and their evolution rules.

Capillaries ; Fibrosis ; Glomerulonephritis, IGA ; pathology ; Glomerulosclerosis, Focal Segmental ; Humans ; Kidney Glomerulus ; Medicine, Chinese Traditional ; Prognosis ; Syndrome

Aim To investigate the effect of curcumin ( CUR) combined with cytarabine( Ara-C) on the pro-liferation and apoptosis of human acute myeloid leuke-mia cell line KG1a and its relationship with autophagy. Methods The optimal combination concentration of curcumin and cytarabine was screened by MTT method and the combined effects were detected. The effects of CUR and Ara-C on the proliferation, autophagy, apop-tosis and cycle of KG1a cells were analyzed. Results Both CUR and Ara-C significantly inhibited the prolif-eration of KG1a cells ( P<0.05) , and showed a dose-and time-dependent manner. The inhibition rate of cells treated with 40 μmol·L-1CUR and 0.5 μmol· L-1 Ara-C was significantly higher than that of the other doses alone. The survival rate of cells pretreated with 3-MA was significantly decreased ( P <0.05 ) . Auto-phagic vacuoles was observed in cells with Acridine or-ange staining methods, the expression rate of the com-bination group was higher than the single group, and can be inhibited by 3-MA. The apoptosis rate of the combined group was higher than that of the single group. The apoptosis rate of the 3-MA pretreatment group was higher than that of the single group ( P <0.05). Cell numbers of the G0/G1 phase were signifi-cantly more than the S phase. The expression of caspase-3, LC3 and Beclin-1 were up-regulated while the Bcl-2 was down-regulated(P<0.05). The protein level of caspase-3 and Beclin-1 of the combination group was significantly higher than that of the single group ( P <0.05 ) , and the ratio of LC3-Ⅱ/LC3-Ⅰwas increased. The Beclin-1 expression and caspase-3 expression in 3-MA pretreatment group decreased ( P<0.05) . Conclusion Curcumin can induce autoph-agy and apoptosis of KG1a cells and increase the sensi-tivity of leukemic cells to cytarabine. Autophagy inhib-itor 3-MA can not only inhibit the autophagy but also promote apoptosis.

Objective:Using an area in east of China as a case,the paper exploit the methodology to define and visualize the scope of the medical insurance pharmacy service through using ArcGIS and its function modules to analy-zing the basic data including this area's population distribution,address of drugstores,administrative districts,road network and soon.Plan A based on the 15-minute walk distance norm for defining the scopes, shows that this area need to increase 548 medical insurances designated drugstore,the effect of which was service area can be increased by 12.36%,service population can be increased by 10.82%, designated drugstore healthy competition rate can be increased by 8.36%;Plan B based on the 10-minute walk distance norm for defining the scopes, displays that this area need to increase 1197 medical insurance designated drugstore, the effect of which was service area can be in-creased by 15.23%,service population can be increased by 20.49%,designated drugstore healthy competition rate can be increased by 19%.

Objective To analyze and estimate the possibility of early control in Shanghai if COVID-19 had begun in Shanghai. Methods Comparison was made in the processes of early control between H7N9 avian influenza in Shanghai in 2013 and COVID-19 in Wuhan in 2019.The early incidence data of Korean COVID-19 was simulated and analyzed to predict whether the medical resources needed in Shanghai were available. Results If it had occurred in Shanghai, it would have taken 22 days from the first case to the government′s emergency response.It was estimated that there would have been 602-763 patients with cumulative onset and onset after incubation period.At least 500 beds of infectious diseases could have been allocated in Shanghai in case of emergency.Through adding beds and resources reallocation in the whole city, patients could have been fully admitted and treated. Conclusion If COVID-19 epidemic had occurred in Shanghai, it′s early control would have been possible though there might have difficulties.

OBJECTIVETo investigate the diagnosis and treatment of neuroendocrine neoplasm (NEN) in the digestive system.

METHODSClinical data of 29 patients with NEN from January 2000 to December 2012 in The First Affiliated Hospital of Dalian Medical University were analyzed retrospectively and the prognosis was evaluated according to the new WHO classification.

RESULTSThere were 19 males and 10 females and the average age was 46.5 years. All the patients had no clinical manifestations of carcinoid syndrome, and they all received surgical treatment. Two cases were gastric neuroendocrine carcinoma(NEC), who received radical total gastrectomy and distal gastric resection respectively. Three cases had neoplasm in the duodenum, including 2 NEC and 1 neuroendocrine tumor(NET), and they all underwent Whipple's procedure. Two cases were small intestine NEC, who received partial small intestine resection. Three cases had neoplasm in the appendix, including 1 NEC treated with right hemicolectomy and 2 NET with appendectomy. One case was ascending colon NEC, who received right hemicolectomy. Eighteen cases had neoplasm in the rectum, including 4 NEC treated with low anterior resection and abdominoperineal resection respectively, and 14 cases of NET underwent low anterior resection, local resection, and endoscopic resection respectively. The 1- and 3- year survival rates of 13 NEC cases were 38.4% and 7.7% respectively. The 5-year survival rate of 16 NET cases was 81.3%.

CONCLUSIONSNEN of digestive system is located mainly in the rectum and the clinical symptom is unspecific. Radical resection of NEN is the preferred treatment. The prognosis of NEC is poor, and that of NET is better.

Digestive System Surgical Procedures ; Female ; Gastrointestinal Neoplasms ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors ; diagnosis ; surgery ; Prognosis ; Retrospective Studies ; Survival Rate

BACKGROUND: The clinical experience of the treatment of the sternoclavicular joint dislocation and peripheral fracture is relatively lacking, but its incidence is increasing yearly. At present, there are few studies on the anatomy and biomechanics of the sternoclavicular joint in and outside China, and no systematic anatomical measurements of the sternoclavicular joint are reported. OBJECTIVE: To provide a biological reference for the clinical diagnosis and treatment of sternoclavicular joint dislocation or peripheral fractures by studying the anatomy and biomechanics of the sternoclavicular joint. METHODS: (1) A total of 16 specimens (32 sides) of adult antiseptic and moist cadaveric specimens were selected. The complete manubrium, bilateral clavicle and surrounding tissues of sternoclavicular joint were anatomically separated, and repair to bone-ligament-bone specimen models. (2) The areas of manubrium articular surface and the medial clavicular articular surface of all specimens were measured by the ink pattern combined with grid counting method. (3) The morphological features of the anterior and posterior sternoclavicular ligaments of the specimens in this group were observed, and the length, width and thickness were measured and analyzed statistically. (4) The left and right sternoclavicular joints of each specimen were randomly paired into A and B groups. Group A received simply cutting of anterior sternoclavicular ligament. Group B received simply cutting of posterior sternoclavicular ligament. Before and after cuting off the ligament, the anterior and posterior load experiments were performed on the anatomical sites with the same force arm length and perpendicular to the distal clavicle. The angles of joints and load-angle regression line slopes were compared between the two groups in the anterior and posterior directions load. RESULTS AND CONCLUSION: (1) The area of articular surface of manubrium (239.00±28.78 mm2) was smaller than the area of medial articular surface of the clavicle (482.56±44.89 mm2), and the difference was statistically significant (t=-40.105, P < 0.001). (2) The length, width and thickness of the anterior sternoclavicular ligament were (17.56±1.94 mm), (15.54±1.42 mm) and (1.93±0.32 mm), and the length, width and thickness of the posterior sternoclavicular ligament were (17.21±1.86 mm), (15.97±1.17 mm), and (2.07±0.29 mm) respectively;there was no significantly statistical difference in the length, width and thickness between them (P > 0.05). (3) Before cutting the ligaments, when the loads were 2, 4, 6, 8, and 10 N, the angle backwards of joint caused by loads in the forward direction was less than the angle of forwards of joints caused by loads in the backward direction, but only when the loads were 6, 8, and 10 N, the difference between them was statistically significant (P < 0.05). The slope of the regression line of load-angle for the loads in the forward direction was less than the slope of the regression line of load-angle for the loads in the backward direction, with statistical difference (F=31.413, P < 0.001). After the ligaments were cut, when the loads were 2, 4, 6, 8 and 10 N in the forward direction in group A and group B, the backward angulation of joint in group A was less than that in group B (P < 0.05). The slope of the load-angled regression line in group A was less than that in group B (F=52.224, P <0.001). When the loads in the backward direction in group A and group B were 2, 4, 6, 8 and 10 N, the forward angulation of joint in group A was greater than that in group B (P < 0.05), and the slope of the load-angled regression line in group A was greater than that in group B (F=12.503, P=0.008). (4) These results suggest that contact area between the articular surface of the medial clavicle and the articular surface of the manubrium is narrow, which determines the instability of the joint itself. The sternoclavicular ligament is extremely important for maintaining the joint stability. The forward angulation of joint restriction effect of sternoclavicular ligament was weaker than that of the backward angulation, also because of the joint in the anatomical position of the natural forward angulation, so the sternoclavicular joint was prone to anterior dislocation. It is necessary to pay attention to the repair and reconstruction of sternoclavicular ligament when sternoclavicular joint dislocation or peripheral fractures are treated by operations.