BACKGROUND: The previous experiments have conformed the traditional Chinese medicine (TCM) Jiannaaan, with the effects of tonifying kidney, promoting blood circulation and resolving phlegm, can inhibit the increased content of glucocorticoid (GC) in 2-24 hours after cerebral ischemic reperfusion (CIR), and reduce toxic effects of promoting nervous cell apoptosis induced by high GC. However, it is unclear whether this effect exists in GC receptor (GR).OBJECTIVE: To observe the intervention of TCM Jiannaoan on GR,further study protective mechanism of Jiannaoan power to hippocampal neurons after CIR, and perform positive control with compound almitrine.DESIGN: A randomized and controlled trial taken animals as subjects.SETTING: Center Laboratory of Beijing University of Chinese Medicine.MATERIALS: The experiment was conducted at the Center Laboratory of Beijing University of Traditional Chinese Medicine between July 2002 and March 2003. Eighty male SD rats were randomized into 5 groups with 16 in each: Sham group, model group, treatment group, positive control group and antagonist group. And each group was divided into 4 subgroups: 2, 6,12 and 24 hours after CIR, with 4 rats at every time point.METHODS:①Administration: Except model group, rats in other 4 groups were administrated by intragastric infusion since 7 days before model establishment, once per day, with dose of 7 μL/g per day distilled water in sham group, 7.39 mg/kg per day compound almitrine in positive control group, 6.7 g/kg per day Jiannaoan crude drug (consisted of desertliving cistanche herb, tatarinowii sweetflag rhizome and rhubarb, etc) in treatment group and 10 g/kg per day GR antagonist mifepristone in antagonist group.② After 7-day administration, the CIR models were prepared on the experimental rats with middle cerebral artery occlusion (MCAO) filament method, while the rats in sham group were sutured after common carotid artery detachment at anesthesia, without filament.MAIN OUTCOME MEASURES: All the rats were executed to take out brains at different time points of reperfusion, and the change of GR protein expression was observed with immunohistochemical method then the amount of positive cells were calculated in 3×200 sight of CA2 region.RESULTS: Totally 80 rats were entered into the result analysis. Compared with uninjured side, the protein expression of GR in model group,treatment group, positive control group and antagonist group were significantly lower than that of sham group (P ＜ 0.05), in which GR expression of injured side was equal to that of uninjured side without significant difference. No obvious change was found in the protein expression of GR among treatment group, positive group and antagonist group at different time points of reperfusion, and no significant difference was found between above groups and model group (P ＞ 0.05).CONCLUSION: Jiannaoan power is selective for adjusting GR and content of GC: Jiannaoan can not adjust expression of GR, identical as compound almitrine; But Jiannaoan can protect the neurons through decreasing the content of GC in plasm and brain tissues after CIR.

Sodium hyaluronate is one of the natural components of articular cartilage and synovial fluid,which plays important roles in maintaining the structure and physiological functions of joints.Abnormal change of the content and physicochemical properties of sodium hyaluronate in the joints is one of the common pathological causes of osteoarthritis.Supplementation of exogenous sodium hyaluronate,which has similar physical and chemical properties as those in normal joints,has been considered as an effective strategy for clinical treatment of osteoarthritis.However,the benefits of intra-articular injection of sodium hyaluronate are still under debates.Moreover,different recommendations for clinical use were developed in several clinical guidelines.Several guidelines suggested that molecular weight of sodium hyaluronate was an important factor influencing the clinical benefits in osteoarthritis.Diverse products of sodium hyaluronate present different physicochemical and biological characteristics,which may lead to differences in clinical efficacy and safety.High-molecular-weight sodium hyaluronate,with highly modified and cross-linked sugar chains,potentially differ from those with low molecular weight in physicochemical properties,rheological characteristics,and physiological activities.In general,high-molecular-weight sodium hyaluronate have higher viscosity and elasticity.The exogenous hyaluronate,of which the molecular weight is similar to those in normal joints,probably have the similar rheological characteristics.A large number of clinical studies demonstrated that sodium hyaluronate products with high-molecular weight significantly relieved joint pain and improved joint functions in patients with osteoarthritis.In contrast,the clinical efficacy of the low-molecular-weight hyaluronate is still controversial,because several studies could not establish the superiority in osteoarthritis when comparing with the placebo.Studies on molecular mechanisms revealed that some physiological functions of sodium hyaluronate were molecular-weight dependent.High-molecular-weight sodium hyaluronate may have more pronounced impacts on the regulation of inflammation and maintaining the homeostasis of extracellular matrix.This review focused on the effects of sodium hyaluronate with different molecular weight in treating osteoarthritis.Evidence based on clinical studies related to the molecular-weight differences of sodium hyaluronate were presented.Furthermore,the optimal use of various products of sodium hyaluronate with different molecular weight was discussed.

OBJECTIVETo evaluate the effect of aorta-iliac bypass total thoracoabdominal aorta aneurysm repair to spinal cord function.

METHODSThis was a prospective study. From June 2014 to April 2015, 31 patients underwent total thoracoabdominal aorta aneurysm repair were treated with aorta-iliac bypass technique. There were 23 male and 8 female patients with a mean age of (36±12) years. A 4-branched tetrafurcate graft was used. The aorta-iliac bypass was established, then distal descending aorta was perfused in a retrograde fashion via bypass graft. Thoracic and abdominal aorta were replaced in a staged fashion. Evoked potentials (EP) monitoring was adopted to assess the spinal cord ischemia throughout the procedure. The intraoperative evoked potentials results, clinical outcomes and follow-up results of this technique were evaluated.

RESULTSThe EP wave disappeared after proximal descending aorta clamped and gradually recovered after the patent segmental arteries reattached. Motor evoked potentials disappeared for (56±18) minutes, somatosensory evoked potentials disappeared for (50±19) minutes. The EP wave was restored to normal at the end of operation in all cases. The somatosensory evoked potentials remained unchanged in 2 cases (false negative). One case died after operation. There were acute kidney dysfunction in 3 cases, and pulmonary haemorrhage in 1 case. No spinal cord injure occurred. The median follow-up after operation was 8 months (ranging from 1 to 11 months). There was no delayed neurologic deficit or relative death.

CONCLUSIONSThere is a transient function loss of spinal cord during the aorta-iliac bypass total thoracoabdominal aorta aneurysm repair. But the process is reversible. The technique of the aorta-iliac bypass is practicable.

Adult ; Aorta, Abdominal ; surgery ; Aortic Aneurysm, Abdominal ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Spinal Cord ; physiopathology ; Vascular Surgical Procedures ; adverse effects

Objective To establish a Chinese expert consensus of the surgical management for type A aortic dissection (TAAD) by using the Delphi method.Methods A systematic review of the previously published literature related to management of TAAD at home and abroad was conducted to formulate a questionnaire of clinical consensus of the surgical treatment for TAAD.This questionnaire including seven aspects of surgical management for TAAD,namely contraindications to operative management,cannulation site,target temperature during circulation arrest,cerebral perfusion strategy,surgical procedure,distal anastomotic technique and surgical management for patients with connective tissue disease such as Marfan syndrome.From October 2015 to April 2016,we performed two rounds Delphi survey in which the current professional opinions from 55 experienced and representative cardiovascular surgeons in China,were gathered and analysed.Results The responses rates of two rounds were 80.0％ (44/55) and 77.27％ (34/44).The scores of authoritative coefficient was 0.87 and 0.83.The coefficient of concordance were 0.31 (P ＜ 0.05) and 0.32 (P ＜ 0.05).After two rounds of consultation,consensus of the surgical management for TAAD was reached on 16 items of seven aspects.Conclusion This Delphi study established an initial Chinese expert consensus concerning the surgical management for TAAD,which drew credible results and reliable conclusions.This study will helo to standardize the surgical management of TAAD in China.

Objective To assess the safety of infliximab (IFX) treatment in patients with Crohn's disease(CD).Methods From January 2009 to May 2018,at inflammatory bowel disease (IBD) center of Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,486 CD patients received the treatment of IFX were enrolled and their clinical data were collected.Univariate and multivariate regression of binary logistic were performed for statistical analysis.Results The median follow-up duration was 31.1 months (12.0 months to 40.0 months).The median duration of IFX therapy was 13.0 months (7.0 months to 21.0 months).Among 486 patients,98 (20.16％) patients reported adverse effects,and 12 (2.47％) patients discontinued the therapy because of adverse effects.Acute infusion reaction was the most common adverse effect in CD patients who received IFX treatment accounting for 41.84％ (41/98) of all the adverse effects,and the incidence was 8.44％.Thirty-nine patients had mild and moderate infusion reaction,and all improved after symptomatic treatment (eight patients discontinued IFX therapy because of recurrent infusion reaction).Two patients developed severe infusion reaction as allergic shock,and both relieved after emergency rescue.Four patients developed late-phase allergic reactions.Among 486 patients,39 (8.02％) patients had infections,including infections of Clostridium difficile,cytomegalovirus,herpeszoster virus,Mycobacterium tuberculosis,and other opportunistic pathogens.There was no cases of infection related death.Thirty-six patients continued with IFX treatment after infection controlled.Among 486 patients,14 (2.88％) patients had severe infection,and all the cases improved after anti-infection treatment.Twenty-seven CD patients with hepatitis B virus (HBV) infection received anti-viral treatments,no active HBV infection was observed.Colon adenocarcinoma was found in one patient under colonoscopy at 22 months after discontinuation of IFX therapy.There were six patients with the history of benign tumors,and no evidence of recurrence,progress or malignancy during treatment.In terms of other rare adverse effects in 486 patients,there were eight (1.64％) patients with liver function injury,two (0.41％) patients with anemia,one (0.21％) patient with peripheral neuropathy,and four (0.82％) patients with skin lesion.Prolonged duration of IFX therapy,without combination of immune-suppressors and with increased baseline body mass index (BMI) were the risk factors of acute infusion reactions.Prolonged duration of IFX therapy and with low baseline albumin level were the risk factors of infections.Conclusions IFX is generally safe as the treatment for CD patients,and its adverse effects can be clinically controlled.Screening before therapy and monitoring during therapy may reduce the risks of adverse effects.

Objective To investigate the clinical application value of contrast-enhanced ultrasound (CEUS) in hepatic artery thrombosis (HAT) after pediatric liver transplantation. Methods Clinical data of 126 pediatric recipients undergoing liver transplantation were retrospectively analyzed. The incidence of HAT after pediatric liver transplantation was summarized. Color Doppler ultrasound and CEUS manifestations of HAT were compared. Results According to color Doppler ultrasound, 17 cases were highly suspected with HAT. Nine cases were highly suspected with HAT by CEUS, who were subsequently confirmed by CT angiography (CTA) or surgery. CEUS manifestations of HAT showed that hepatic artery was not seen surrounding the portal vein during the arterial phase or even portal venous phase. Hepatocyte necrosis occurred in 4 patients with HAT, and no perfusion of intrahepatic contrast agent was observed on CEUS. Conclusions CEUS yields high clinical application value in the diagnosis of HAT after pediatric liver transplantation. It has significant advantages compared with traditional CTA, which could be widely applied in clinical practice.

Objective To evaluate the application value of quantitative parameters of contrast-enhanced ultrasound (CEUS) in evaluating the donor liver from donation after brain death (DBD). Methods Clinical data of 25 DBD donor livers and 10 healthy adult livers were retrospectively analyzed. CEUS examinations of DBD donor livers and healthy livers were collected. Quantitative parameters included the area under curve (AUC), maximum intensity (I_max), time to peak (TTP) and mean transit time (mTT), etc. Results Among 25 cases of DBD donor livers, 23 cases showed normal enhancement pattern, and the other 2 cases presented with abnormal enhancement pattern. Compared with the control group, the AUC, I_max and mTT values of DBD donor livers were significantly decreased (all P < 0.05). Conclusions CEUS quantitative parameters can be effective means to evaluate the micro-perfusion of DBD donor livers.

Objective:To evaluate the treatment persistence and long-time safety of infliximab (IFX) in the real-world in Chinese patients with Crohn′s disease (CD).Methods:From January 2009 to December 2021, at Sir Run Run Shaw Hospital, School of medicine, Zhejiang University, the clinical data of 1 309 patients with CD and treated with IFX were retrospectively analyzed, which included baseline data (gender, age at diagnosis, follow-up time, etc.), usage of IFX (the duration of treatment and situation of discontinuation) and adverse effects of IFX. Kaplan-Meier method was used to calculate the rate of consistent use of IFX and Cox regression was performed to analyze the influencing factors of treatment persistence. The chi-square test was used to analyze the associations between different factors and safety outcomes.Results:Among 1 309 patients, 936 (71.5%) were male, age at diagnosis was 28.7 years (28.1 years, 29.3 years). The follow-up time was 3.9 years (3.7 years, 4.0 years). The longest time of IFX treatment was 9.4 years. During the follow-up period, a total of 421 (32.2%) patients discontinued use of IFX and the sustained use of IFX at year 1, 3, 5 and 10 were 84.0%, 65.8%, 56.7% and 30.9% respectively. The results of Cox regression analysis revealed that patients with perianal lesions had an increased rate of sustained use of IFX ( HR(95% confidence interval) 0.75 (0.61, 0.92), P=0.006), while patients with adverse reactions had a decreased rate of sustained use of IFX ( HR(95% confidence interval) 1.23(1.01, 1.50), P=0.038). A total of 445 patients experienced adverse events, with an incidence rate of 34.0% (445/1 309). The acute infusion reaction was the most common side with an incidence rate of 13.7% (179/1 309), of which the rate of severe acute infusion reaction was 2.8% (5/1 309). The rate of infection was 10.5% (138/1 309), among which the rate of severe infection was 2.6% (34/1 309), and the rate of special pathogens infection was 5.5% (72/1 309). The rate of tuberculosis infection was 1.0% (13/1 309), and the most common affected site was the lungs (10 cases). The incidence of skin lesions (non-allergic, non-infectious and non-tumor skin) was 6.9% (90/1 309). The incidence of tumor was 1.1% (14/1 309). Patients who discontinued IFX due to adverse reactions accounted for 20.7% (92/445) of the patients with adverse reactions, among them patients who discontinued IFX due to acute infusion reaction, infections, neoplasms, delayed infusion reaction, skin lesions, abnormal liver function, hematological disorder, acute pancreatitis, joint pain and seizure accounted for 47.8% (44/92), 18.5% (17/92), 8.7% (8/92), 6.5% (6/92), 5.4% (5/92), 5.4% (5/92), 3.3% (3/92), 2.2% (2/92), 1.1% (1/92) and 1.1% (1/92), respectively. Among 14 patients with tumor, 11 were malignant tumors, 1 case of chronic leukemia was related with IFX. Multi-round of IFX treatment increased the risk of acute infusion reaction and severe acute infusion reaction, combination of immunosuppressants decreased the risk of liver injury, and IFX treatment for more than 1 year increased the risk of skin lesions ( χ2=6.16, 11.30, 18.20 and 9.47; P=0.013, =0.001, <0.001, =0.002). Conclusions:The rate of constant use of IFX is relatively high in Chinese Crohn′s disease patients. The long-term safety is good. Clinicians should pay more attention on the safety of patients receiving multiple rounds and long courses of IFX treatment.

Total thoracoabdominal aortic aneurysmrepair is one of the most complex operations in cardiac surgery. Patients may have spinal cord injury, disturbance of consciousness, hypoxemia, arrhythmia, acute renal injury, abdominal organ ischemia and so on after operation. Postoperative complications may occur in patients with neurological, respiratory, circulatory, digestive, urinary and coagulation systems. This paper summarizes the experience of prevention and treatment of postoperative complications based on the medical literature at home and abroad and the experience of diagnosis and therapeutic schedule in our hospital, in order to improve the prognosis.

Objective: To investigate the role of LncRNA RP11-20 G6.3 and Toll-like receptor 4(TLR4)/nuclear factor kappa-B(NF-κB) signaling pathway in airway inflammation and remodeling in chronic obstructive pulmonary disease(COPD). Methods: The wild-type(WT) and TLR4 knock out(KO) C57 BL/6 male mice were used to construct COPD model. The expression of TLR4/NF-κB signaling pathway protein was analyzed by Western blot; the levels of interleukin-1β(IL-1β), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in bronchoalveolar lavage fluid( BALF) were detected by enzyme-linked immunosorbent assay( ELISA). The differentially expressed LncRNAs were identified by RNA sequencing and functional enrichment analysis,and the competing endogenous RNAs( ceRNA) networks were predicted using RNAhybrid. Luciferase reporter was used to explore relationships between genes. Results: In COPD model, compared with WT mice, the lung inflammation of TLR4-/-mice was significantly reduced,the expression of NF-κB related protein,the levels of inflammatory factors( IL-1β,IL-6 and TNF-α) in BALF and Masson trichromatic staining area significantly decreased in TLR4-/-mice. RNA sequencing and functional enrichment analysis confirmed that RP11-20G6. 3 was one of the differentially expressed LncRNA. RP11-20G6. 3 was up-regulated in lung tissue of COPD patients,and its expression was significantly correlated with FEV1( ρ = 0. 549,P = 0. 047). RP11-20G6. 3 plasmid intervention aggravated the inflammation of lung tissue in TLR4-/-COPD mice,and increased the Masson tricolor area around bronchi and the levels of inflammatory factors( IL-1β,IL-6 and TNF-α) in BALF. Luciferase reporter gene analysis showed that RP11-20G6. 3 acted as a ceRNA for miR-34c-5p in COPD,and sponges the latter to upregulate Col1a1. Conclusion TLR4/NF-κB relays the damage signals following COPD and activates the downstream RP11-20G6. 3/miR-34c-5p/Col1a1 ceRNA network which triggers airway inflammation and remodeling.