OBJECTIVES: To explore the mechanism of Shuangshu Decoction (SSD) for inhibiting growth of gastric cancer xenografts in nude mice. METHODS: Network pharmacology analysis was conducted to identify the common targets of SSD and gastric cancer cell ferroptosis, and bioinformatics analysis and molecular docking were used to validate the core targets. In the cell experiment, AGS cells were treated with SSD-medicated serum, Fer-1 (a ferroptosis inhibitor), or both, and the changes in cell viability, ferroptosis markers (ROS, Fe²⁺ and GSH), expressions of P53, SLC7A11 and GPX4, and mitochondrial morphology were examined. In a nude mouse model bearing gastric cancer xenografts, the effects of gavage with SSD, intraperitoneal injection of Fer-1, or their combination on tumor volume/weight, histopathology, and expressions of P53, SLC7A11 and GPX4 levels were evaluated. RESULTS: The active components in SSD (quercetin and wogonin) showed strong binding affinities to P53. In AGS cells, SSD treatment dose-dependently inhibited cell proliferation, increased ROS and Fe²⁺ levels, upregulated P53 expression, and downregulated the expressions of SLC7A11 and GPX4, but these effects were effectively attenuated by Fer-1 treatment. SSD also induced mitochondrial shrinkage and increased the membrane density, which were alleviated by Fer-1. In the tumor-bearing mouse models, gavage with SSD significantly reduced tumor size and weight, caused tumor cell necrosis, upregulated P53 and downregulated SLC7A11 and GPX4 expression in the tumor tissue, and these effects were obviously mitigated by Fer-1 treatment. CONCLUSIONS SSD inhibits gastric cancer growth in nude mice by inducing cell ferroptosis via the P53/SLC7A11/GPX4 axis.
Ferroptosis/drug effects* ; Animals ; Stomach Neoplasms/metabolism* ; Tumor Suppressor Protein p53/metabolism* ; Mice, Nude ; Phospholipid Hydroperoxide Glutathione Peroxidase ; Drugs, Chinese Herbal/pharmacology* ; Humans ; Amino Acid Transport System y+/metabolism* ; Mice ; Cell Line, Tumor ; Cell Proliferation/drug effects* ; Xenograft Model Antitumor Assays

Objective To investigate the predictive value of heparin-binding protein(HBP)in Kawasaki disease complicated with bacterial infection.Methods A total of 148 children with Kawasaki disease in this hospital from April 2021 to June 2022 were selected as Kawasaki disease group.According to the results of pathogen detection during hospitalization,the children were divided into three subgroups:Mycoplasma pneu-moniae group(36 cases),bacteria group(19 cases),and non-infection group(93 cases).In addition,35 chil-dren with fever and upper respiratory tract infection were randomly selected as the case control group.HBP and other inflammatory markers[white blood cell count(WBC),neutrophil percentage(NE％),procalcitonin(PCT),C reactive protein(CRP),interleukin-6(IL-6)]in each group were detected and analyzed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of HBP and PCT for bacterial infection in children with Kawasaki disease.Results The levels of HBP,WBC,NE％,CRP and IL-6 in the Ka-wasaki disease group were significantly higher than those in the case control group(P＜0.05),while there was no significant difference in PCT level between the two groups(P＞0.05).The levels of HBP,WBC,NE％,PCT,CRP and IL-6 in children with Kawasaki disease after treatment were significantly lower than those at admission(P＜0.05).The levels of HBP and PCT in the bacterial group were higher than those in the Mycoplasma pneumoniae group and the non-infection group,and the differences were statistically signifi-cant(P＜0.05),while there were no statistically significant differences in WBC,NE％,CRP and IL-6 levels a-mong the three groups(P＞0.05).ROC curve results showed that the area under the curve(AUC)and 95％CI of HBP for predicting bacterial infection in children with Kawasaki disease was 0.77(0.68-0.86),when HBP was 499.65 ng/mL,the sensitivity and specificity were 84.2％and 66.7％,respectively.When PCT was 0.85 ng/mL,the AUC(95％CI)for predicting bacterial infection in children with Kawasaki disease was 0.65(0.52-0.78),and the sensitivity and specificity were 63.2％and 65.9％,respectively.Conclusion HBP is associated with Kawasaki disease,and it has certain predictive value for Kawasaki disease complicated with bacterial infection.

Objective:To study the clinical effect of sacrospinous ligament fixation (SSLF) and traditional vaginal hysterectomy on pelvic organ prolapse (POP) .Methods:A retrospective analysis was performed on 68 patients with POP of degree II-IV admittedl from Jan. 2017 to Dec. 2019. Among them, 33 patients were treated with SSLF (observation group) and 35 patients were treated with vaginal total hysterectomy (control group). Intraoperative blood loss, operative time, postoperative indwelling catheter and average length of hospital stay were compared between the two groups. The patients were followed up for 6 months, and the scores of pelvic floor dysfunction questionnaire-20 (PFDI-20) and sexual quality questionnaire -12 (PISQ-12) were used to evaluate the subjective satisfaction degree of postoperative recovery.Results:In the observation group, the intraoperative blood loss (173.94±52.14) ml, postoperative indurating catheter time (2.72±0.45) d and average length of hospital stay (7.09±0.63) d were observed. There were statistically significant differences in intraoperative blood loss (228.86±53.40) ml, postoperative induration time (4.54±0.61) d and mean hospital stay (9.22±0.81) d in the control group ( P<0.05). There was no significant difference in the operation time between the observation group (99.57±9.50) min and the control group (101.06±8.64) min, ( P>0.05). The improvement of PFDI-20 and PISQ-12 in both groups was significant before and after treatment. The PISQ-12 score of the observation group was higher than that of the control group 6 months after surgery, and the difference was statistically significant ( P <0. 05). There was no significant difference in PFDI-20 score between the two groups ( P>0.05). There was statistical significance in the positions of pop-Q indicators in the two surgical methods ( P < 0.05) . Conclusions:SSLF with uterus preservation and total vaginal hysterectomy are both effective in treatment of moderate and severe POP. However, SSLF with uterus preservation has less intraoperative blood loss, and the postoperative recovery is significantly better than that with total vaginal hysterectomy. In addition, it satisfies patients’ desire to preserve uterus, improves the postoperative sexual life quality, which is worthy of promotion.

Objective:To evaluate the clinical outcome of the reconstruction of finger-pulp defects, using modified dorsal digital fasciocutaneous flap.Methods:Between June 2018 and March 2019, 14 patients with finger-pulp defects were admitted to the Department of Hand and Foot Surgery. There were 14 males and 2 females, aged from 27 to 63 years, with the mean age of 49 years. The defect areas of finger pulp were 1.6 cm × 1.4 cm-2.5 cm × 1.6 cm. All of the finger-pulp defects were treated by the modified dorsal digital fasciocutaneous flap and the inverted L-shaped incision was made at the distal part of the pedicle. The defects at donor sites were reconstructed with full-thickness skin grafts harvested from the forearm. Viability of the flap was recorded postoperatively. At the last follow-up, aesthetics, sensibility of the flap and hand performance were assessed.Results:All of the 14 flaps survived successfully, the areas were 1.8 cm×1.6 cm-2.7 cm×1.8 cm. Partial distal blister occurred on the flap in only one case, which was solved by aspiration without surgical intervention. All cases acquired follow-up visits for 5 to 12 months with a mean time of 8.9 months. The texture of flaps was similar to surrounding skin and the shape of reconstructed finger pulp was satisfactory. According to the assessment of total active movement, the results were excellent in 9 fingers, good in 5 fingers. The 2-point discrimination of flap was 8 to 11 mm (mean, 9.9 mm).Conclusions:It is an effective and simple method for the reconstruction of finger-pulp defects using modified dorsal digital fasciocutaneous flap. The clinical effectiveness is definite.

Objectives:To explore the value of heparin-binding protein (HBP) in the diagnosis and prognosis of patients with respiratory viral infections.Methods:The patients who were admitted to Emergency Department of Nanjing Hospital Affiliated to Nanjing Medical University from November 2018 to November 2020 were selected as the viral infection group, and the non-infected patients admitted in the same period as the non-viral infection group. Data of all patients’ general clinical information, peripheral white blood cell count (WBC), neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), procalcitonin (PCT), and HBP in 24 h were collected. The differences in various indicators were compared between the two groups of patients, the receiver operating characteristic (ROC) curves were drawn, and the diagnostic value of each indicator for patients with respiratory virus infection were evaluated. The prognostic indicators such as sequential organ failure assessment (SOFA) score, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 h were recorded, and duration of ICU stay, antiviral treatment, ventilator and vasoactive agents to total length of hospital stay of patients in the viral infection group were calculated. The Spearman correlation analysis of HBP and the above indicators was performed to determine the prognostic value of HBP in patients with respiratory virus infections.Results:A total of 106 patients were included in the viral infection group, and 107 in the non-viral infection group. There were no significant differences in sex, age, and body mass index (BMI) between the two groups of patients (P>0.05). Compared with the non-viral infection group, the serum CRP and HBP of the viral infection group were significantly higher (P<0.05), while the WBC and NLR levels were significantly lower (P<0.05). There was no statistical difference in PCT between the two groups (P>0.05). HBP had the best diagnosis efficiency for respiratory viral infections, the areas under the ROC was 0.895, the optimal cut-off point was 13.625 μg/L, the sensitivity was 92.50% and the specificity was 76.60%. Correlation analysis showed that serum HBP levels within 24 h in the viral infection group were positively correlated with SOFA score and APACHEⅡ score in 24 h after admission (r = 0.756, P<0.05; r = 0.747, P<0.05). In the viral infection group, duration of ICU stay, antiviral treatment, and ventilator and vasoactive agents to total length of hospital stay were also positively correlated with serum HBP level (r = 0.873, 0.748, 0.830, and 0.794, P<0.05).Conclusions:HBP can be used as a favorable diagnostic indicator for patients with respiratory virus infections and has a good evaluation value for the prognosis.

Objective:To evaluate the clinical outcome of the reconstruction of finger-pulp defects, using modified dorsal digital fasciocutaneous flap.Methods:Between June 2018 and March 2019, 14 patients with finger-pulp defects were admitted to the Department of Hand and Foot Surgery. There were 14 males and 2 females, aged from 27 to 63 years, with the mean age of 49 years. The defect areas of finger pulp were 1.6 cm × 1.4 cm-2.5 cm × 1.6 cm. All of the finger-pulp defects were treated by the modified dorsal digital fasciocutaneous flap and the inverted L-shaped incision was made at the distal part of the pedicle. The defects at donor sites were reconstructed with full-thickness skin grafts harvested from the forearm. Viability of the flap was recorded postoperatively. At the last follow-up, aesthetics, sensibility of the flap and hand performance were assessed.Results:All of the 14 flaps survived successfully, the areas were 1.8 cm×1.6 cm-2.7 cm×1.8 cm. Partial distal blister occurred on the flap in only one case, which was solved by aspiration without surgical intervention. All cases acquired follow-up visits for 5 to 12 months with a mean time of 8.9 months. The texture of flaps was similar to surrounding skin and the shape of reconstructed finger pulp was satisfactory. According to the assessment of total active movement, the results were excellent in 9 fingers, good in 5 fingers. The 2-point discrimination of flap was 8 to 11 mm (mean, 9.9 mm).Conclusions:It is an effective and simple method for the reconstruction of finger-pulp defects using modified dorsal digital fasciocutaneous flap. The clinical effectiveness is definite.

The process of sex development in children is complex and sequential. The diseases and etiologies associated with sex development are various, and laboratory indexes evaluating the diseases are scarce, which lead to the difficulty in diagnosis. Anti-Müllerian hormone(AMH) is a kind of reproductive hormone closely related to sex development. At present, AMH is widely used to evaluate ovarian reserve and to assist in the field of reproduction. AMH takes part in the process of sex development regulated by hypothalamic-pituitary-gonadal axis, and the change of AMH level may indicate the occurrence of diseases associated with sex development in children. This review will focus on the clinical application of AMH in precocious puberty, delayed puberty and disorders of sex development.

Objective: To explore the clinical value of determining heparin-binding protein(HBP) of cerebrospinal fluid(CSF) in the diagnosis and prognostic prediction in children with purulent meningitis(PM). Methods: 76 children with PM, 55 children with viral encephalitis(VE) and 40 control children with non-infectious diseases, all admitted to Hunan Children′ Hospital from August 2018 to January 2019, were enrolled in this retrospective study. Children with PM were divided into favorable prognosis group and poor prognosis group according to the Glasgow Outcome Scale on discharge. CSF HBP, white blood cell count(WBC), percentage of neutrophilic granulocyte(N%), glucose(Glu), total protein(TP), lactic dehydrogenase (LDH) and serum procalcitonin(PCT) were analyzed on the first day of admission(DAY1) in PM group, VE group and control group, and on the seventh day of admission(DAY7) in PM group. Nonparametric tests were used to detect the differences of the laboratory indexes and Spearman rank correlation test was utilized to analyze the correlation between HBP and other markers. Receiver operating characteristic curves (ROC curves) were established to evaluate the values of the detection indexes in the diagnosis and prognosis of PM. Results: The differences of CSF HBP[63.09(18.10-272.19)ng/mL, 5.90(5.90-6.40)ng/mL and 5.90(5.90-5.90)ng/mL], WBC[365.00(20.00-1285.00)×10⁶/L, 21.00(8.00-30.00)×10⁶/L and 13.50(7.25-21.00)×10⁶/L], N%[0.65(0.50-0.79), 0.19(0.10-0.25) and 0.21(0.15-0.27)], Glu[1.97(1.07-3.08)mmol/L, 2.89(2.66-3.42)mmol/L and 3.04(2.68-3.42)mmol/L], TP[1.43(0.63-1.88)g/L, 0.23(0.16-0.32)g/L and 0.13(0.10-0.31)g/L], LDH[152.00(46.50-461.50)IU/L, 16.00(13.20-22.00)IU/L and 16.00(10.25-19.75) IU/L] and serum PCT[1.35(0.19-9.33)ng/mL, 0.06(0.03-0.11)ng/mL and 0.08(0.05-0.14)ng/mL] levels on DAY1 were statistically significant among PM group, VE group and control group(H_HBP=138.62, H_WBC=69.72, H_N%=106.67, H_Glu=34.08, H_TP=68.00, H_LDH=85.11, H_PCT=79.20, P<0.001). HBP had the largest area under curve(AUC=0.997) for the diagnosis of PM, and had excellent sensitivity, specificity, positive predictive value, negative predictive value (98.70%, 97.90%, 97.40%, 98.94%, respectively) at the optimal cut-off value (11.84 ng/mL). Compared with DAY1,CSF HBP, WBC, N%, TP, LDH and serum PCT levels on DAY7 were statistically lower in favorable prognosis group(P<0.05). The differences for all the indexes between DAY1 and DAY7 in poor prognosis group were not statistically significant, however. It was not significant for all the indexes on DAY1 to predict poor prognosis(P>0.05). But the indexes on DAY7 for predicting poor prognosis were significant (P<0.05) and HBP still had the largest AUC (0.976) for predicting the poor prognosis with good sensitivity, specificity, positive predictive value, negative predictive value (100.0%, 93.8%, 76.3%, 100.0%, respectively) at the optimal cut-off value(128.84 ng/mL). CSF HBP was positively correlated to CSF WBC, N%, TP, LDH, serum PCT level(r_WBC=0.670, r_N%=0.802, r_TP=0.562, r_LDH=0.524, r_PCT=0.436, P<0.001) and negatively correlated to CSF Glu level(r=-0.469, P<0.001). Conclusions CSF HBP is valuable in the diagnosis and prognostic prediction in children with purulent meningitis.

Objective To study the change and clinical value of thrombomodulin (TM ) in children with se-vere pneumonia .Methods Sixty-five children cases of severe pneumonia were divided into the disseminated in-travascular coagulation (DIC) group and non-DIC group according to whether complicating DIC .And 30 healthy children were selected as the control group .Plasma TM levels were analysed and compared among the three groups .The receiver operating characteristic(ROC) curve was used to conduct the evaluation .Results The plasma TM level had statistically significant difference among the control group ,non-DIC group and DIC group(H=53 .14 ,P=0 .000) ,moreover the pairwise comparison also had statistical difference (P<0 .05) .A-mong sputum culture positive 24 cases of severe pneumonia complicating DIC ,the T M level had no statistical difference between the children patients with Gram-positive bacterial infection and children patients with Gram-negative bacterial infection(P>0 .05) .The area under ROC curve of TM for diagnosing DIC was 0 .74 . The sensitivity ,specificity ,positive likelihood ratio and negative likelihood ratio were 0 .76 ,0 .63 ,2 .05 and 0 .38 respectively .Conclusion The change of plasma TM level is associated with the severity of children with severe pneumonia ,and T M can be used as one of the reference indicators for the early diagnosis in children with severe pneumonia complicating DIC .

Objectives To study the signiifcance of ifbrin related markers such as ifbrin monome (FM), D-dimer (D-D), fibrinogen and fibrin degradation products (FDP) in diagnosis of pre-disseminated intravascular coagulation (pre-DIC) state in children with severe pneumonia. Methods A total of 213 children with severe pneumonia in pediatric intensive care unit were divided into pre-DIC group and case control group according to the occurrence of pre-DIC. And 40 healthy children were included as normal control group. FM、D-D、FDP、prothrombin time (PT)、activated partial thromboplastin time (APTT)、ifbrinogen (FIB)、platelet count (PLT)、thrombomodulin (TM) levels were analyzed. Receiver operating characteristic curve was used to evaluate the above indexes. Results All the markers but FIB showed signiifcant difference among the three groups (P<0 . 05 ). The differences of FM、D-D、FDP、APTT in paired comparison among the three groups were also signiifcant (P<0.01), Pre-DIC group had the highest level and case control group was the second. Pre-DIC group had higher PT than that of the other two groups (P<0 . 05 ), but PT levels in normal control group and the control group are of no signiifcant difference (P>0 . 05 ). Compared with those in normal control group, TM and PLT levels were signiifcantly higher in the other two groups (P<0 . 01 ), but the differences of TM and PLT in pre-DIC group were not signiifcant in comparison to those in case control group (P>0 . 05 ). FM、D-D、FDP had larger area under curves (AUC) for pre-DIC than other indexes ( 0 . 84、0 . 76、0 . 64 , respectively). The AUC for the joint detection of the three indexes was 0 . 85 . Conclusions Fibrin related markers such as FM、D-D and FDP are valuable indexes in diagnosis of pre-DIC state in children with severe pneumonia, the joint detection of the three indexes would help to improve diagnostic accuracy.