Objective To investigate the incidence and influencing factors of aldosterone breakthrough during therapy with angiotensin Ⅱ receptor blockers (ARB) alone,or combined with angiotensin-converting enzyme inhibitors (ACEI) in Chinese patients with non-diabetic nephropathy.Methods A total of 144 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB for a mean follow-up period of 12 months.Aldosterone breakthrough was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment.Results In 6 months,aldosterone breakthrough occurred in 21 patients,corresponding to 14.58％,while in 12 months,occurred in 39 patients,corresponding to 27.08％.Although the overall urinary protein excretion (UPE) decreased after treatment in both groups (P＜0.05),non-breakthrough group had a more remarkable reduction in UPE (P＜0.05).Univariate Logistic regression demonstrated that risk factors of aldosterone breakthrough included pre-treatment values of UPE (OR=3.643,P=0.073) and eGFR (OR=0.980,P=0.025).Multivariate Logistic model revealed pre-treatment values of eGFR was positively associated with aldosterone breakthrough (OR=0.980,P=0.025).Conclusions The incidence of the aldosterone breakthrough increases with duration of treatment.The patients with aldosterone breathrough have higher level of UPE,and enhanced decline in eGFR.Pretreatment value of eGFR is independent risk factor of aldosterone breakthrough.

Objective To investigate the therapeutic efficacy of Chinese medicine of Wusheng Tincture for external application in treating cancer pain, and to observe its effect on the quality of life ( QOL) of cancer patients. Methods Eighty-three cancer pain patients were randomized into treatment group (N=42) and control group (N=41). Except 5 cases dropping out for the itch of skin, a total of 78 cases finished the treatment, 40 in the treatment and 38 in the control group. The patients were given the corresponding medicine according to the classification of numerical rating scale ( NRS) scores. In the control group, the patients were treated following the three-step analgestic ladder issued by World Health Organization ( WHO). The treatment group was given external application of Wusheng Tincture on the painful regions based on the same three-step analgestie ladder treatment as that of the control group, the treatment course lasting 7 days. The rating scale NRS scores and QOL scores were observed for the assessment of therapeutic effect and QOL of the two groups. Results (1) On medication day 7, NRS scores in both groups were decreased as compared with those one day before treatment (P<0.01), but the differences between the two groups were insignificant (P>0.05) . (2) The total effective rate of the treatment group was 82.5%, and that of the control group was 68.4%, the difference being significant between the two groups ( P<0.05) . For mild-pain patients, the therapeutic effect of the treatment group was better than that of the control group (P<0.05) . However, the difference of the therapeutic effect for patients with moderate and severe pain was insignificant between the two groups ( P>0.05) . ( 3) On medication day 7, QOL scores were much lower in both groups than those one day before medication, the difference being significant ( P<0.01) . However, the difference of QOL scores between the two groups was insignificant after medication (P>0.05) . Conclusion External application of Wusheng Tincture may have certain therapeutic effect in treating patients with mild cancer pain, but fails in enhancing the effect for patients with moderate and severe pain, either in improving the QOL of cancer pain patients when used together with WHO three-step analgestic ladder.

Objective:To determine the effect of miR-122-5p on microglia polarization, apoptosis and inflammation after traumatic brain injury (TBI).Methods:A mouse model and an in vitro TBI model were established. Astrocytes were stimulated to synthesize and release exosomes by brain extracts. microRNA microarray analysis was used to analyze the significantly altered microRNAs. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was applied to detect the expression of miR-122-5p in the in vivo and in vitro TBI model. TUNEL, immunofluorescence, and Western blot were performed to detect the effects of miR-122-5p inhibitors on microglia apoptosis, microglia M1/M2 phenotype transformation and the activation of NLRP3 inflammasome pathway and the phosphorylation of NF-κB after TBI.Results:The results of microRNA microarray analysis showed that 83 miRNAs were downregulated significantly (altered more than 2 folds, P < 0.05), among which miR-122-5p was significantly down-regulated ( P < 0.01). Expression of miR-122-5p was significantly decreased in the in vivo and in vitro TBI model [(1.00±0.00) vs. (0.41±0.15), P < 0.001; (1.00±0.00) vs. (0.34±0.07), P < 0.001]. TUNEL and immunofluorescence showed that miR-122-5p inhibitor significantly alleviated microglia apoptosis[(8.03±1.30) vs. (3.17±0.34), P < 0.001] and promoted microglia M1→M2 phenotype transformation ,M1 phenotype polarization was reduced [(56.96±13.70) vs. (34.70±3.47), P =0.002] and M2 phenotype polarization was increased [(30.46±3.67) vs. (40.74±2.49), P =0.005]. Western blot showed that NLRP3 inflammasome activation was inhibited and NF-κB phosphorylation was decreased when miR-122-5p was downregulated[(0.77±0.10) vs. (0.51±0.11), P =0.02; (0.73±0.08) vs. (0.50±0.07), P =0.003]. Conclusions:miR-122-5p is downregulated in microglia and exosomes secreted by astrocytes after TBI. miR-122-5p inhibitor can attenuate the microglia inflammatory response after TBI by inhibiting the activation of NLRP3 inflammasome pathway and the phosphorylation of NF-κB, promoting the microglia M1→M2 phenotypic transformation and reducing microglia apoptosis, thereby reducing the microglia inflammatory injury after TBI.

Objective:To investigate the clinical efficacy and safety of programmed death protein 1 (PD-1) inhibitos combined with Fuzheng Kang'ai Decoction in patients with stage Ⅲ or Ⅳ non-small cell lung cancer (NSCLC) and identify factors that influence progression and prognosis in real world.Methods:Objective response rate (ORR), disease control rate (DCR), progression free survival (PFS), total survival time (OS) and adverse events of patients with advanced or metastatic NSCLC who received PD-1 inhibitors for the first time in the Department of Oncology, Guangdong Provincial Hospital of Chinese Medicine from August 2018 to March 2021 were retrospectively analyzed, and was prospectively followed up until September 2022. Kaplan-Meier method was used to plot survival curves and evaluate median PFS and median OS, while Cox proportional hazards regression model was used for multivariate analysis.Results:The final 66 patients were included in the study, with an ORR of 33.3% (22/66), a DCR of 86.4% (57/66), a median PFS of 9.90 months, and a median OS of 31.83 months. Univariate analysis showed that median PFS was associated with TNM stage, liver metastasis, PD-L1 expression level, lung immune prognostic index (LIPI), and traditional Chinese medicine syndrome types ( P values were 0.004, 0.033, 0.040, 0.004, and 0.001, respectively). Multivariate Cox regression analysis showed that TNM stage [ HR (95% CI)=4.179 (1.781, 9.804)], PD-L1 expression level 1%-49% [ HR (95% CI)=0.346 (0.127, 0.940)] or ≥ 50% [ HR (95% CI)=0.074 (0.019, 0.288)], LIPI [ HR (95% CI)=14.515 (2.939, 71.681)], and TCM characteristics of deficiency of yang qi [ HR (95% CI)=5.954 (2.093, 16.940)] were independent influencing factors for PFS. The overall and grade 3-5 treatment-related adverse events were 68.2% (45/66) and 9.1% (6/66), respectively. Conclusions:Fuzheng Kang'ai Decoction combined with PD-1 inhibitors is an effective and tolerable therapy for patients with advanced or metastatic NSCLC. TNM stage, liver metastasis, PD-L1 expression, LIPI and TCM characteristics are early predictors of clinical efficacy for patients with stage Ⅲ/Ⅳ NSCLC that receive traditional Chinese medicine combined with immunotherapy .

Objective:To investigate the correlation between acoustic radiation force impulse imaging(ARFI) and reserve function of liver and the feasibility of liver reserve function assessment by ARFI.Methods:According to the inclusion criteria, 74 patients were screened and 71 patients were finally enrolled from Henan Province People′s Hospital during June 2017 and June 2019. The portal vein diameter (D PV), spleen length (L SP) were measured by two-dimensional ultrasound. The liver shear wave velocity (LSWV) and spleen shear wave velocity (SSWV) were measured by ARFI. Serological markers were checked, and the indocyanine green (ICG)15-minute retention rate (ICG R15) was measured by excretion test. The patients were divided into ICG R15<10% group and ICG R15≥10% group, the difference of the measurements between two groups were calculated, the correlations of the measurements and ICG R15 were analyzed. LSWV diagnostic performance for liver reserve function was evaluated by the ROC curve. Results:There were significant differences in LSWV, D PV, SSWV, L SP, aspartate transaminase(AST), alkaline phosphatase(ALP), y-glutamyl transpeptidase(γ-GGT) and albumin (ALB) between ICG R15<10% group and ICG≥10% group( P<0.05), but no significant differences in other measurements( P>0.05). The correlations between ICG R15 and LSWV( r=0.673, P<0.001), D PV( r=0.355, P<0.05), SSWV( r=0.384, P<0.05), L SP( r=0.403, P<0.001), ALP( r s=0.245, P<0.05) and ALB( r s=-0.390, P<0.05) were statistically significant. The ROC curve showed high diagnostic performance for liver reserve function assessment by LSWV. The area under the ROC curve was 0.903 (95% CI=0.810-0.961, P<0.01), and the cut-off value was 2.15 m/s (sensitivity 84.6%, specificity 86.7%). Conclusions:The LSWV can evaluate the reserve function and it is a useful supplement to the ICG excretion experiment.

OBJECTIVETo examine the HIV prevalence and associated risk factors among men who have sex with men (MSM) in the Pearl River Delta (PRD) region, in order to provide scientific basis for assessment on HIV prevention programs.

METHODSSurveillance projects on HIV infection status and risk factors were carried out among MSM in six prefectural PRD cities, based on the national sentinel surveillance program among MSM.

RESULTSA total of 8 770 MSM were recruited in the six PRD prefectural cities from 2009 to 2013. The overall prevalence rates of HIV among MSM during 2009 and 2013 were 4.7% , 9.7% , 10.6% , 12.9% and 11.4% , respectively, appeared an increasing trend. HIV related high-risk behaviors were commonly seen among MSM. The proportion of consistent condom use during anal sex in the last six months was 46.3%. Associated risk factors for HIV infection among MSM would include older age, being non-permenant residents, inconsistent condom use, history of having had sexually transmitted diseases and without having received intervention services in the last year.

CONCLUSIONHigh-risk behaviors were popular in the MSM population that causing the HIV transmission to expand among the MSM population in the major region of PRD. It seemed necessary to reinforce the publicity and education programs as well as effective behavior intervening measures among the MSM group.

HIV Infections ; epidemiology ; Homosexuality, Male ; psychology ; statistics & numerical data ; Humans ; Male ; Prevalence ; Risk Factors ; Safe Sex ; Sexual Behavior ; psychology ; Sexually Transmitted Diseases

OBJECTIVE: To summarize the clinical data of patients who experienced cryoablation in minimally invasive mitral valve surgery and to explore safety and effectiveness of the surgery.
 METHODS: We retrospectively collected the clinical data of patients who experienced cryoablation in minimally invasive mitral valve surgery in Department of Cardiovascular of Second Xiangya Hospital from August 2013 to July 2015. Through a right side (4-6 cm) thoracotomy, femoral cannulation and aortic cross-clamp by Chitwood clamper was performed, left atrium was entered from interatrial groove. Modified left and right side cryomaze followed by valve surgery was finished. The left atrial appendage was excluded by oversewing from endocardial surface. The cardiopulmonary bypass time, cross-clamp time, duration in hospital were recorded. The heart rhythm of 3 consecutive post operation days, at 7th day, 3 months, 6 months, 12 months or 18 months after the surgery was monitered by 12-leads electrical cardiogram.
 RESULTS: No death was observed in this group. Reexploration for bleeding was conducted for one case. Operation time, CBP time and cross-clamp time was (197.4±27.2), (103.6±20.3)and (65.3±15.7) min, respectively. Duration in ICU and hospital was (1.2±0.4) and (9.2±1.6) d, respectively. The ratio of sinus rhythm restoration right after surgery was 97.1%. The ratio of sinus rhythm restoration at the time of hospital discharge was 94.3%. No motality was found in follow-up. The ratio of sinus rhythm restoration at 3, 6, 12,18 months after the surgery was 94.3%, 93.5%, 90.5%, 93.3%, respectively.
 CONCLUSION Right minimal invasive thoracoscopic-assisted cryoablation in mitral valve surgery is quite effective in the treatment of atrial fibrillation, displaying the advantages of less complications, motality and hospitalization.
Aorta ; Atrial Fibrillation ; Cardiac Surgical Procedures ; Cryosurgery ; Heart Atria ; Humans ; Minimally Invasive Surgical Procedures ; Mitral Valve ; Retrospective Studies ; Surgical Instruments ; Thoracotomy