Biliary atresia (BA) is one of the most serious digestive system diseases, which threatens the health of infants. Liver fibrosis is a major cause of death in children with BA. In the process of the pathogenesis of BA, virus infection can in?duce a series of immune and inflammatory reaction, result in a decrease of regulatory T cells (Treg cells) and high expression of CD14, activating a variety of inflammatory pathways and TGF-β/Smad2/3 pro-fibrogenic pathway, which produces a large number of medium damage of liver cells and bile duct cells, releases proinflammatory factor, oxygen metabolism matter and cytokines. These changes further aggravate damage of hepatobiliary system and cause the internal environment imbalance of liver parenchyma cells. The imbalance of internal environment with adaptive degeneration and necrosis in liver parenchyma cells, hepatic macrophages and gathered inflammatory cells leads to the activation of hepatic stellate cells (HSCs). HSCs can be converted into fibroblast cells, and promote the process of liver fibrosis. Immune and inflammatory lesions, pro-fibrogenic pathway are the important factors in contributing to liver fibrosis and cirrhosis of biliary atresia.

Pathological myopia can induce choroidal neovascularization (PM-CNV).The potential risk factors include ageing,long axial length of the eyeball,thinning of subfoveal choroidal thickness,fundus atrophy spot and lacquer crack.These factors may induce atrophy of retinal pigment epithelial cells (RPE) and hypoxia,resulting in vascular endothelial growth factors (VEGF) secretion by outer retina.The lesion type,location and activity of PM-CNV can be determined by fundus fluorescein angiography.The features of PM-CNV on optical coherence tomography include strong reflective area close to RPE with very small amount of subretinal fluid (active stage),surface strong reflection with signal attenuation area (scar stage) and flat lesion and chorioretinal atrophy (atrophy stage).Photodynamic therapy and intravitreal injection of anti-VEGF drugs are major treatments for PM-CNV,the latter is more commonly used now.However,more large randomized controlled studies are required to explore the treatment regimen (such as frequency,indications for repeated or termination of treatment) and the efficacy factors further.

s:Professor SHAO Zhao-di is a famous old TCM doctor. She has been engaged in clinical of TCM for a long time, with extensive acquaintance and experiences. This article discussed three cases of her to treat allergic purpura nephritis.

BACKGROUND: A good many researches believe that the gene polymorphism of vascular endothelia nitric oxide synthase(eNOS) correlate with diseases of heart, brain and kidney. However, it is still not clear whether eNOS Glu298Asp correlates with myocardial infarction in the elderly Chinese.OBJECTIVE: To investigate the distribution of Glu298Asp polymorphism of vascular eNOS in the elderly as well as correlation between Glu298Asp polymorphism of eNOS and myocardial infarction in the elderly Chinese.DESIGN: A case-controled study based on diagnosis.SETTING, PARTICIPANTS and METHODS: A total of 37 patients with myocardial infarction were selected into case group, which all of them were patients from either outpatient department or inpatient department of the First Affiliated Hospital of Nanjing Medical University. Thereinto, 20 cases without hypertensive history were allocated into case subgroup. Totally 172 subjects selected from the re-testees of physical checkup of our hospital were assigned into control group, of which 92 cases without hypertensive history were allocated into control subgroup. Indices like height, body mass and fasting blood sugar were detected respectively in all participants of all groups. The polymorphism of Glu298Asp of eNOS gene was assayed by polymerase chain reaction(PCR), and restriction fragment length polymorphism (RELP).MAIN OUTCOME MEASURES: The polymorphism of Glu298Asp of eNOS gene as well as the allelic frequency of 298Asp in the elderly of four groups.RESULTS: Genotype of Glu/Asp of the case group was higher than that of the control group(32.43% and 18.02% respectively) . The genotype composition of Glu298Asp polymorphism had significant difference between the case group and the control group(x2 = 3.87, P < 0. 05) . Between normotensive subgroups, Genotype Glu/Asp of the case subgroup was higher than that of the control subgroup(35.00% and 10. 87% respectively) . The genotype composition of Glu298Asp polymorphism of the eNOS gene also had significant difference between the case subgroup and the control subgroup (x2 = 7.43, P < 0.01) . The allelic frequency of 298Asp of the case group was higher than that of the control group without statistical significance (16. 22% and 9.01% respectively, P > 0. 05) . Between normotensive subgroups, the allelic frequency of 298Asp of the case subgroup was significantly higher than that of the control subgroup(17.50% and 5.43% respectively, x2 = 6.82, P < 0.01 ) ).CONCLUSION: Glu298.Asp polymorphism of the eNOS gene exists in the elderly Chinese. The genotype of Glu/Asp and allelic frequency of 298Asp might be a genetic susceptible marker of myocardial infarction in the elderly Chinese.

Objective To investigate the expression and function of transforming growth factor (TGF)-β1 and Smad2 in liver fibrosis of biliary atresia (BA). Methods Liver biopsy specimens were collected from autopsy (normal group, n=5), congenital biliary dilatation (CBD group, n=10), BA patients underwent Kasai procedure (early hepatic fibrosis group, n=19) and liver transplantation (transplantation group, n=11). The first three groups were collected from January 2010 to July 2014 in Tianjin Children’s Hospital, and the last group was collected from January 2013 to January 2014 in Tianjin First Central Hospital. The hematoxylin and eosin (HE) stain were used to observe the degree of liver fibrosis of four groups. Immunohistochemistry (IHC) was used to observe expressions of TGF-β1 and Smad2 in liver tissues of these samples. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to test the quantitative mRNA of TGF-β1 and Smad2 in these samples. Results Results of HE showed that no fibrosis in autopsy group, mild fiber cell hyperplasia in CBD group, severe fibrosis in Kasai group and significant pseudolobule in transplantation group. Results of IHC showed that TGF-β1 was expressed in the cytoplasm of hepatocytes, bile duct cells, lymphocytes and neutrophils. The average optical density of TGF-β1 was the highest in Kasai group compared with that of other three groups (P < 0.05). There was no significant difference in Smad2 expression in cytoplasm of hepatocytes, bile duct cells and lymphocytes between four groups (P>0.05). Results of qRT-PCR showed that both TGF-β1 mRNA and Smad2 mRNA were the highest in early hepatic fibrosis group than those of CBD group and transplantation group (P<0.017). Conclusion In early stage of BA, TGF-β1 and Smad2 promote liver fibrosis until the formation of P-P,P-C desmosome structure. However, with BA fibrosis becomes more serious, the pro-fibrogenic function of TGF-β1 and Smad2 becomes less.

OBJECTIVE: To compare the effects of manipulation treatment and transcutaneous electrical nerve stimulation (TENS) on patients with cervicogenic headache. METHODS: Seventy patients with cervicogenic headache were randomly allocated to receive manipulation treatment and TENS treatment, which were given every other day respectively for total 40 days. The headache degree (numeric rating scale, NRS), frequency, lasting time and the range of motion (ROM) of the cervical spine 2 weeks before treatment and 4 weeks after treatment, were compared. RESULTS: Before treatment, there were no significant differences in the headache NRS scores , frequency, lasting time and the ROM scores between the two groups (P>0.05). After treatment, the headache NRS score, frequency, lasting time in the manipulation group decreased significantly (P<0.01), while in the TENS group just the headache NRS score decreased significantly (P<0.05). The ROM scores in both groups showed no significant changes (P>0.05). The response rate of manipulation treatment is 94.5%, significantly higher than 64.5% of TENS treatment (P<0.05). CONCLUSION: The manipulation treatment is an effective method for patients with cervicogenic headache.

Objective To explore the association of Glu298Asp polymorphism of the endothelial nitric oxide synthase gene (eNOS) with myocardial infarction in Chinese aged people based on a case-control study. Methods Thirty-seven patients with myocardial infarction and 172 sex- and age-matched healthy control subjects were enrolled. Their height, weight and blood pressure were measured and the fasting plasma lipid concentrations were examined. Glu298Asp polymorphisms of the eNOS gene were examined using PCR and RFLP methods. Results Genotype Glu/Asp in the patient group was higher than that in the control group (32.4% vs 18.0%). The genotype composition of Glu298Asp polymorphism showed significant difference between the patient group and the control group ( =3.87, P 0.05). Among the normotensive subgroup, the allelic frequencies of 298Asp in the patient subgroup was higher than that in the control subgroup (17.5% vs 5.4%). The allelic frequencies of 298Asp had significant difference between the patient subgroup and the control subgroup ( =6.82, P

HIV-1 integrase enzyme is a 32kDa protein encoded by HIV pol gene. It is responsible for integration of viral cDNA into host chromosomal DNA, which is indispensable for HIV replication.Since there was no functional equivalent for this enzyme in human cells, inhibition of integrase will bring little side effect to human body. Thus HIV integrase has become an attractive and rational target for therapy of AIDS after reverse transcriptase and protease.The Recent research on HIV-1integrase structure,inhibitors and new therapeutic method target at HIV integrase was reviewed.

Objective To investigate the prevalence of anxiety and depression in elderly patients with metabolic syndrome (MS) and its related factors.Methods A total of 672 subjects aged 60 or over undergoing health check-up in two Nanjing community health service centers from November 2015 to October 2016 were enrolled in the study.The basic information and the history of hyperlipidemia,hypertension and diabetes were collected by questionnaire survey;the results of physical examination and biochemical testing were documented.The prevalence of anxiety and depression were investigated by the Hospital Anxiety and Depression Scale (HADS).According to MS diagnostic criteria,the subjects were divided into MS group (n=181) and non-MS group (n=491).The HADS scores of two groups were compared and the influencing factors related to anxiety and depression were analyzed.Results The levels of systolic blood pressure (SBP),diastolic blood pressure (DBP),body mass index(BMI),levels of fasting blood glucose (FBG),triglyceride (TG),low density lipoprotein cholesterol (LDL-C) were higher and high density lipoprotein cholesterol (HDL-C) was lower in MS group than those in non-MS group (all P<0.05).The prevalence rates of anxiety and depression in MS group (30.9% and 34.8%) were significantly higher than those in non-MS group (20.2% vs.25.1%,χ2=8.655,6.288,P=0.003,0.012).Multivariate logistic regression analysis showed that obesity (BMI≥28 kg/m2),high FBG (≥7.0 mmol/L),hypertension [blood Pressure≥140/90 mmHg (1 mmHg=0.133 kPa)] were the independent risk factors for anxiety in MS patients (OR=3.987,2.827,2.375,respectively,all P<0.05);obesity (BMI≥28 kg/m2),high FBG(≥7.0 mmol/L),smoke,high TC (≥5.2 mmol/L),hypertension (≥140/90 mmHg) were the independent risk factors for depression in MS patients (OR=7.718,3.233,2.071,1.932,1.910,respectively,all P<0.05).Conclusion Elderly patients with metabolic syndrome are prone to anxiety and depression,and obesity,high FBG,hypertension and other factors are the risk factors for anxiety and depression.