Objective To analyze the therapeutic effect and mechanism of Neferine(Nef)on psoriasis mice based on the nuclear factor E2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway.Methods A mouse model of psoriasis was constructed.The 50 mice with successful modeling were divided into the model group,the L-Nef group,the M-Nef group,the H-Nef group,and the H-Nef+ML385 group,with 10 mice in each group according to random number table method.Additionally,10 normal mice were selected as the control group.The L-Nef group,M-Nef group and H-Nef group were respectively administered 5,10 and 20 mg/kg Nef by gavage.The H-Nef+ML385 group was administered 20 mg/kg Nef by gavage and intraperitoneally injected with 30 mg/kg Nrf2/HO-1 signaling pathway inhibitor ML385.The control group and the model group were given the same amount of normal saline.The changes of skin lesions in each group of mice were observed and the psoriasis area and severity index(PASI)scoring was conducted.HE staining and toluidine blue staining were used to observe the pathological changes of the skin and the number of mast cells in each group,and immunohistochemical staining was used to observe the expression of Ki-67 in the lesion sites of mice in each group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammation and oxidative stress factors in the skin lesion tissues of mice in each group,and Western blot was used to detect the expression of Nrf2/HO-1 signaling pathway-related proteins in the skin lesion tissues of mice in each group.Results Compared with the control group,the mice in the model group presented symptoms such as skin erythema and scales,and the pathological changes of the skin lesion tissue were severe.The PASI score,the number of mast cells,Ki-67,tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),interleukin-6(IL-6),interleukin-17A(IL-17A),and malondialdehyde expressions were increased,while the expressions of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),Nrf2 and HO-1 were decreased(P<0.05).Compared with the model group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in mice of the L-Nef group,M-Nef group and H-Nef group were alleviated,and the PASI score,the number of mast cells,the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A and malondialdehyde were significantly reduced;however,the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly increased(P<0.05).Compared with the H-Nef group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in the H-Nef+ML385 group of mice were more severe.The PASI score,the number of mast cells,and the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A,and malondialdehyde were significantly increased.while the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly decreased(P<0.05).Conclusion Nef may have therapeutic effects by activating the Nrf2/HO-1 signaling pathway to improve the inflammation and oxidative stress responses in the lesion tissues of mice with psoriasis.

Objective To analyze the therapeutic effect and mechanism of Neferine(Nef)on psoriasis mice based on the nuclear factor E2-related factor 2(Nrf2)/heme oxygenase-1(HO-1)signaling pathway.Methods A mouse model of psoriasis was constructed.The 50 mice with successful modeling were divided into the model group,the L-Nef group,the M-Nef group,the H-Nef group,and the H-Nef+ML385 group,with 10 mice in each group according to random number table method.Additionally,10 normal mice were selected as the control group.The L-Nef group,M-Nef group and H-Nef group were respectively administered 5,10 and 20 mg/kg Nef by gavage.The H-Nef+ML385 group was administered 20 mg/kg Nef by gavage and intraperitoneally injected with 30 mg/kg Nrf2/HO-1 signaling pathway inhibitor ML385.The control group and the model group were given the same amount of normal saline.The changes of skin lesions in each group of mice were observed and the psoriasis area and severity index(PASI)scoring was conducted.HE staining and toluidine blue staining were used to observe the pathological changes of the skin and the number of mast cells in each group,and immunohistochemical staining was used to observe the expression of Ki-67 in the lesion sites of mice in each group.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of inflammation and oxidative stress factors in the skin lesion tissues of mice in each group,and Western blot was used to detect the expression of Nrf2/HO-1 signaling pathway-related proteins in the skin lesion tissues of mice in each group.Results Compared with the control group,the mice in the model group presented symptoms such as skin erythema and scales,and the pathological changes of the skin lesion tissue were severe.The PASI score,the number of mast cells,Ki-67,tumor necrosis factor-α(TNF-α),interferon-γ(IFN-γ),interleukin-6(IL-6),interleukin-17A(IL-17A),and malondialdehyde expressions were increased,while the expressions of superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),Nrf2 and HO-1 were decreased(P<0.05).Compared with the model group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in mice of the L-Nef group,M-Nef group and H-Nef group were alleviated,and the PASI score,the number of mast cells,the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A and malondialdehyde were significantly reduced;however,the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly increased(P<0.05).Compared with the H-Nef group,the symptoms such as skin erythema and scales and the pathological changes of skin lesion tissues in the H-Nef+ML385 group of mice were more severe.The PASI score,the number of mast cells,and the expressions of Ki-67,TNF-α,IFN-γ,IL-6,IL-17A,and malondialdehyde were significantly increased.while the expressions of SOD,GSH-Px,Nrf2 and HO-1 were significantly decreased(P<0.05).Conclusion Nef may have therapeutic effects by activating the Nrf2/HO-1 signaling pathway to improve the inflammation and oxidative stress responses in the lesion tissues of mice with psoriasis.

AIM: To investigate the differences in varying stages of non-proliferative diabetic retinopathy(NPDR)using optical coherence tomography angiography(OCTA).METHODS: Cross-sectional study. A total of 77 cases(77 eyes)of diabetic patients were included, and they were divided into non-diabetic retinopathy(NDR; 23 eyes)and non-proliferative diabetic retinopathy(NPDR; 54 eyes)groups, further subdivided into mild NPDR(20 eyes), moderate NPDR(20 eyes), and severe NPDR(14 eyes). Foveal avascular zone(FAZ)area, superficial and deep capillary plexus densities(SSP and DSP), and visual acuity(LogMAR)were compared between NDR and NPDR groups. Furthermore, the visual acuity, FAZ area and levels of SSP and DSP were compared in different degrees of NPDR. Correlation analysis were conducted to elucidate relationships between FAZ area, visual acuity, SSP, DSP, and severity of the disease.RESULTS: Compared with the NDR group, the visual acuity(LogMAR)and macular FAZ area increased, while SSP and DSP were decreased in the NPDR group(P<0.05); there were significant differences in visual acuity, FAZ area and SSP and DSP levels in different degrees of NPDR(P<0.05). Visual acuity(LogMAR)and FAZ area displayed a positive correlation with the severity of disease, while SSP and DSP showed a negative correlation.CONCLUSION: With the progression of NPDR, the visual acuity(LogMAR)and FAZ area increased, and the SSP and DSP decreased.

Conversion therapy has become the core in the treatment of borderline resectable or unresectable liver cancer, which provides resectable opportunities for more advanced liver cancer patients. In accordance with the first-choice treatment regimen recommended by the guidelines, the authors reported a successful case of Atezolizumab and Bevacizumab (T+A regimen) conversion therapy. The patient with initially borderline resectable advanced liver cancer was performed liver segment resection sucessfully after conversion therapy, and non-tumor recurrence was observed at postoperative 9 months. Postoperative pathological examination showed combined hepatocellular-cholangiocarcinoma, which also indicated the important value of T+A regimen in the conversion therapy of combined hepatocellular-cholangiocarcinoma.

Breast cancer is the most common cancer in women all over the world, and it is also the main cause of cancer death in women. In 2018, there were about 2.09 million of new breast cancer cases and 630 thousand of death cases worldwide. The incidence rate of breast cancer varies in different regions of the world, but all of them were on the rise. Although the incidence (36.1/10⁵) and mortality (8.8/10⁵) of female breast cancer in China were relatively low worldwide, the number of female breast cancer cases and deaths in China ranks first in the world. Moreover, the incidence and mortality of female breast cancer in China are increasing in recent year. Breast cancer is a multifactorial disease, mainly including genetic factors, environmental factors and behavioral lifestyle factors, etc. This review aims to explore the epidemiology and related risk factors of breast cancer in the world, so as to understand the prevalence of breast cancer and provide help for the prevention, intervention and early detection of breast cancer.

Lung cancer is the most common malignant tumor in the world. The five-year survival rate is 19.7%, which seriously threatens human health. Lung cancer screening is an effective measure to reduce lung cancer mortality. Existing studies have shown that screening with low-dose computed tomography (LDCT) can reduce lung cancer deaths by 20%. Currently, lung cancer screening is recommended internationally and nationally. Studying the development status of lung cancer screening helps us to identify the high-risk groups of lung cancer, explore reasonable screening programs, improve the cost-effectiveness of screening and reduce the economic burden. Therefore, this article summarizes the current status of lung cancer screening, the cost-effectiveness of lung cancer screening and the existing problems as follows.
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Objective:To evaluate the safety and effectiveness of The Stork OTC conception aid kit for the treatment of male infertility compared with natural sexual intercourse.Methods:A multi-center, prospective, open, self-controlled, randomly crossed trial was performed in 57 infertility couples who were unable to naturally conceive, and were selected in Shanghai General Hospital, Shanghai Jiao Tong University, Reproductive Medicine Center,Tongji Medical College, Huazhong University of Science and Technology and Anhui Provincial Hospital from July 2017 to September 2018. Patients were required to participate both the conception aid kit and natural sexual intercourse in two consecutive periods of ovulation. A random envelope method was used to determine the application sequences of two methods. Twenty-nine couples were treated with the conception aid kit in the first month of ovulation, and applied the natural sexual intercourse in the second month of ovulation as group A. Twenty-eight couples were applied the natural sexual intercourse in the first month of ovulation, and were treated with the conception aid kit in the second month of ovulation as group B. Test results collected from all couples who used the conception aid kit were categorized as the test group data. Meanwhile, test results out of those couples who completed natural sexual intercourse were collected as control group data. Compared with its self-controlled natural sexual intercourse two months before and after, the effectiveness and safety of the conception aid kit was verified by general vaginal examination, routine leucorrhea examination, motile sperm score from post coital test (PCT), pregnancy rate comparison and other methods.Results:The trial was conducted at three clinical trial centers. A total of 57 infertility couples were enrolled. A total of 54 couples were validated eventually including 26 couples in group A and 28 infertility couples in group B. Effectiveness was evaluated. The PCT results showed that the sperm score of test group was 6.11±3.00, and the score of the sperm score of control group was 1.22±0.79. The motile sperm score of test group was 5 times ( P<0.001) than that in control group. In the follow-up, 7 (13.0%) of the couples successfully achieved pregnancy with the conception aid kit, 6 (85.7%) of them had healthy offspring, 1 (14.3%) had spontaneous abortion. No couples were pregnant after natural sexual intercourse. Safety was evaluated. The general examination of the vagina and the routine tests of the vaginal leukorrhea showed no difference between test group and control group. All 54 effective couples who completed the test can successfully use the conception aid kid to place the seminal vesicles containing semen and remove them with the attached pulling thread on time without obvious discomfort. Conclusion:The Stork OTC conception aid kits can effectively treat infertility, significantly increase the number of forward-moving sperm entering the cervix, and significantly increase the pregnancy rate. It is safe, non-invasive, simple, can be easily operate by patients themselves, and meets the needs of clinical applications.

Objective:To evaluate the safety and effectiveness of The Stork OTC conception aid kit for the treatment of male infertility compared with natural sexual intercourse.Methods:A multi-center, prospective, open, self-controlled, randomly crossed trial was performed in 57 infertility couples who were unable to naturally conceive, and were selected in Shanghai General Hospital, Shanghai Jiao Tong University, Reproductive Medicine Center,Tongji Medical College, Huazhong University of Science and Technology and Anhui Provincial Hospital from July 2017 to September 2018. Patients were required to participate both the conception aid kit and natural sexual intercourse in two consecutive periods of ovulation. A random envelope method was used to determine the application sequences of two methods. Twenty-nine couples were treated with the conception aid kit in the first month of ovulation, and applied the natural sexual intercourse in the second month of ovulation as group A. Twenty-eight couples were applied the natural sexual intercourse in the first month of ovulation, and were treated with the conception aid kit in the second month of ovulation as group B. Test results collected from all couples who used the conception aid kit were categorized as the test group data. Meanwhile, test results out of those couples who completed natural sexual intercourse were collected as control group data. Compared with its self-controlled natural sexual intercourse two months before and after, the effectiveness and safety of the conception aid kit was verified by general vaginal examination, routine leucorrhea examination, motile sperm score from post coital test (PCT), pregnancy rate comparison and other methods.Results:The trial was conducted at three clinical trial centers. A total of 57 infertility couples were enrolled. A total of 54 couples were validated eventually including 26 couples in group A and 28 infertility couples in group B. Effectiveness was evaluated. The PCT results showed that the sperm score of test group was 6.11±3.00, and the score of the sperm score of control group was 1.22±0.79. The motile sperm score of test group was 5 times ( P<0.001) than that in control group. In the follow-up, 7 (13.0%) of the couples successfully achieved pregnancy with the conception aid kit, 6 (85.7%) of them had healthy offspring, 1 (14.3%) had spontaneous abortion. No couples were pregnant after natural sexual intercourse. Safety was evaluated. The general examination of the vagina and the routine tests of the vaginal leukorrhea showed no difference between test group and control group. All 54 effective couples who completed the test can successfully use the conception aid kid to place the seminal vesicles containing semen and remove them with the attached pulling thread on time without obvious discomfort. Conclusion:The Stork OTC conception aid kits can effectively treat infertility, significantly increase the number of forward-moving sperm entering the cervix, and significantly increase the pregnancy rate. It is safe, non-invasive, simple, can be easily operate by patients themselves, and meets the needs of clinical applications.

Objective To access the influence factors of diagnostic delay of endometriosis. Methods We designed a questionnaire of diagnostic delay of endometriosis. From February 2014 to February 2016,400 patients who had dysmenorrhea and diagnosed with endometriosis by surgery in Peking University Third Hospital were surveyed retrospectively. Time and risk factors of diagnostic delay were analyzed.Results The diagnostic delay of 400 patients was 13.0 years(0.2-43.0 years),78.5%(314/400) patients thought pain was a normal phenomenon and didn′ t see the doctor. Patients who suffered dysmenorrhea at menarche experienced longer diagnostic delay than those who had dysmenorrhea after menarche(18.0 vs 4.5 years;Z=191.800,P<0.01).Patients who suffered aggravating dysmenorrhea experienced shorter delay time than those who suffered stable or relieving dysmenorrhea(11.0 vs 12.5 vs 18.0 years;Z=8.270, P<0.05), with the difference statistically significant, single factor analysis shows. Severe dysmenorrhea, deep infiltration endometriosis(DIE), family history of dysmenorrhea or endometriosis, previous surgical history of endometriosis,high stage,with infertility,adenomyoma or other symptoms,could help to shorten diagnostic delay with no significant difference(P>0.05). By multiple logistic regression analysis,the results shown that whether have dysmenorrhea at menarche and clinical diagnosis time were the independent factors affecting delayed diagnosis(P<0.01).Conclusions Diagnostic delay of endometriosis is common and the mean delay time is 13.0 years mainly due to the unawareness of dysmenorrhea. Dysmenorrhea at menarche,clinical diagnosis time and dysmenorrhea intensity are the factors affecting time of diagnostic delay.

ObjectiveTo investigate the features and methods of clinical diagnosis and treatment of elderly patients with acute calculous cholecystitis. MethodsA retrospective analysis was performed for the clinical data of elderly patients who were diagnosed with acute calculous cholecystitis in 451 Hospital of PLA from June 2012 to June 2015. After admission, all patients received fasting treatment, electrocardiographic monitoring, anti-infective therapy, and maintenance of body fluid balance and stable blood pressure and glucose. According to patients condition choose laparoscopic cholecystectomy open cholecystectomy, open cholecystectomy and common bile duct exploration. ResultsA total of 129 patients were enrolled; among these patients, 119 had acute calculous cholecystitis, 2 had gallstones with adenomatous hyperplasia of the gallbladder mucosa, 6 had pyogenic cholecystitis, and 2 had gallbladder gangrene. Among the patients enrolled, 52 were complicated by at least one internal disease. Among them, 67 underwent emergency surgery since there were no significant improvements in symptoms, and 62 showed relief of symptoms and underwent surgical treatment at other times. Of all patients, 108 underwent laparoscopic cholecystectomy, 9 underwent laparoscopy and were converted to open cholecystectomy, and 9 underwent open cholecystectomy and common bile duct exploration. All the surgeries were successful and all the patients were cured and discharged. There were no deaths. ConclusionElderly patients with acute calculous cholecystitis are in a critical condition and often complicated by various internal diseases. Laparoscopic cholecystectomy is the most commonly used therapeutic method. Clinicians should be fully prepared before surgery, take the perioperative management seriously, and accurately judge the surgical indications and timing.