AIM:To investigate the effect of Huangqi-Danggui decoction(HQDG)on the brain tissue of rats with cerebral ischemia/reperfusion(I/R)injury for 7 d by regulating macroautophagy and chaperone-mediated autophagy(CMA),and to explore its mechanism.METHODS:Male SD rats were randomly divided into sham group,model group,HQDG group and Xuesaitong(XST)group.Determination of main chemical components of HQDG by liquid chro-matography-mass spectrometry.The model of middle cerebral artery occlusion/reperfusion in rats was established by the left modified thread embolism method,and the changes of cerebral blood flow were observed by laser speckle blood flow imager.Zea Longa score was used to observe the neurological deficit.HE staining was used to observe the degree of nerve cell injury.The changes of neurovascular unit and autophagosomes in brain tissue were observed by transmission electron microscopy.Immunohistochemical method was used to detect the expression of LC3,P62,lysosome-associated membrane protein-2A(LAMP-2A),heat shock protein 70(HSP70)and myocyte enhancer factor 2D(MEF2D)proteins.Western blot was used to detect the expression of autophagy-related proteins P62 and LC3-Ⅱ/LC3-I.RESULTS:Compared with the sham group,the neurological deficit score in model group was significantly higher(P<0.01).A large number of nerve cells showed necrosis and nuclear dissolution,with the cell arrangement being disordered.The number of autophagosomes increased.The protein expression levels of LC3,LAMP-2A,HSP70 and MEF2D in brain tissue increased,while the ex-pression level of P62 protein decreased(P<0.05 or P<0.01).Compared with the model group,the scores of neurological deficit in brain tissue in HQDG and XST groups were significantly lower(P<0.01).Cell damage was significantly re-duced.The number of autophagosomes further increased.The expression levels of LAMP-2A,HSP70,MEF2D and P62 proteins in brain tissue decreased,while the expression levels of LC3-Ⅱ/LC3-I protein increased(P<0.05 or P<0.01).CONCLUSION:HQDG can alleviate cerebral ischemia/reperfusion injury in rats and exert neuroprotective effects by ac-tivating macroautophagy and reducing CMA.

Patients with novel coronavirus infection still have many functional disorders during the recovery period. The timely intervention of rehabilitation treatment has important clinical significance in improving the patients’ functions and their ability of daily living. Based on the current evidence of evidence-based medicine and clinical practice, this paper summarizes the rehabilitation treatment and precautions of patients with simple novel coronavirus infection and different groups with previous dysfunction and novel coronavirus infection (such as neurological dysfunction, chronic pain, and bone and joint diseases) with a view to providing clinical reference for the rehabilitation treatment of patients with novel coronavirus infection during the recovery period.

Objective To assess the aMAP risk in prediction of hepatocellular carcinoma (HCC) risk in outpatients with chronic hepatitis B virus (HBV) infection. Methods A total of 709 patients with chronic HBV infection were recruited for calculation of the aMAP scores and then stratified for HCC risk statistically. The t -test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results Among these 709 patients, 22.4% had complicated with alcoholic liver disease, 11.8% with diabetes mellitus. 18.6% with fatty liver, 19.0% with liver cirrhosis, and 9.7% with liver cancer. Among all patients, 71.2% received oral antiviral medicine. Moreover, the highest aMAP score was 75.2 and the low, medium and high HCC risks were 70.0%, 23.1%, and 6.9% respectively in these patients. The proportion of patients with high HCC risk was higher among those with alcohol liver disease, diabetes mellitus, and liver cirrhosis than those without these complications (9.4% vs 6.2%; 11.9% vs 6.2%; and 19.3% vs 4.0%). The mean annual change in aMAP score was 0.93±2.05 in patients without antiviral treatment that was higher than -1.15±1.72 in patients with antiviral treatment ( t =39.36; P < 0.001). In addition, the proportion of these patients with high HCC risk three years before HCC diagnosis was 38.4%, 26.7%, and 33.3% respectively. The median of aMAP score was more than 50 three years before diagnosis liver cancer, data of which indicated that this change was earlier than that of AFP. Conclusion aMAP is a simple convenient marker for screening early HCC in outpatient with chronic HBV infection and complications, especially in those patients with alcohol liver disease, diabetes, and cirrhosis. Oral antiviral therapy could reduce aMAP in patients with chronic HBV infection.

Objective To compare the clinical efficacy between Clamshell incision and bilateral posterolateral incision in the sequential double lung transplantation for end-stage lung disease. Methods Clinical data of 120 recipients undergoing double lung transplantation were retrospectively analyzed. All recipients were divided into bilateral posterolateral incision group (n=108) and Clamshell incision group (n=12) according to different surgical methods. Intraoperative parameters were collected and statistically compared between two groups, including operation time, amount of blood loss, amount of blood transfusion, use of extracorporeal membrane oxygenation (ECMO) or not, cold ischemia time on the first side, and cold ischemia time on the second side. Postoperative parameters were also compared between two groups, including the length of hospital stay, length of intensive care unit (ICU) stay, tracheal intubation duration, ECMO duration, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), incidence of anastomotic stenosis, incidence of bronchopleural fistula, perioperative fatality, and 6-minute walk test for the first time after operation. Results In the Clamshell incision group, the amount of blood loss and blood transfusion was significantly higher than those in the bilateral posterolateral incision group (both P < 0.05). The proportion of ECMO and cold ischemia time on the second side in the Clamshell incision group were significantly lower or shorter than those in the bilateral posterolateral incision group (both P < 0.05). In the Clamshell incision group, the tracheal intubation duration and ECMO duration were significantly shorter compared with those in bilateral posterolateral incision group (both P < 0.05). Conclusions Both Clamshell incision and bilateral posterolateral incision are safe and effective in sequential double lung transplantation. Bilateral posterolateral incision approach can significantly reduce the amount of blood loss and blood transfusion of the recipients without significantly prolonging the operation time. Compared with bilateral posterolateral incision approach, the cold ischemia time of lung graft, tracheal intubation duration and ECMO duration are significantly shortened via the Clamshell incision.

[Abstract] Objective: To investigate the effect of HMGB1 gene on the growth of human epithelial ovarian cancer xenografts in nude mice, and to lay a foundation for finding new targets for the treatment of ovarian cancer. Methods: Human epithelial ovarian cancer SKOV3 cells in logarithmic growth phase were selected to establish a human epithelial ovarian cancer xenograft model in nude mice. Nude mice with successful model establishment were randomly divided into control group and HMGB1-siRNA group. On the 7th, 9th, 11th, 14th, and 16th days after cell inoculation, the same amount of saline and HMGB1-siRNA were respectively injected into two groups of mice under the armpit.After 3 weeks, the nude mice were sacrificed by cervical dislocation, the tumor tissues were separated, and the volume of the tumor was measured. The apoptosis of transplanted tumor cells was detected by Tunnel staining. The expressions of HMGB1, STAT3 and p-STAT3 were detected by Western blotting. The expression of vascular endothelial growth factorA(VEGF-A) and microvascularization were detected by immunohistochemistry. Results: Compared with the control group, the growth of tumor volume slowed down in HMGB1 siRNA group, and on the 21st day, the tumor volume of HMGB1-siRNA group was significantly smaller than that of the control group (P<0.05). HMGB1-siRNA successfully knocked down the expression of HMGB1 mRNA in transplanted tumor tissue. The apoptosis rate of tissue cells in HMGB1-siRNA group was significantly increased ([34±8]% vs [6±2]%, P=0.04), and the expressions of HMGB1 and p-STAT3 were significantly reduced (P<0.05). The expression of VEGF-Aand the number of microvessels were significantly lower than those of the control group (both P<0.05). Conclusion: Knockdown of HMGB1 gene reduces the expression of VEGF-A and microvessel formation possibly by inhibiting the HMGB1/STAT3 signaling pathway, thereby promoting the apoptosis of tumor tissues and slowing the growth of xenografts.

Objective:To investigate the expression changes of SKOV3 and MRTFA in ovarian cancer and their effects on tumor cell proliferation and invasion.Methods:91 cases of patients with ovarian cancer admitted to our hospital from Jun. 2017 to May. 2019 were enrolled in this study. The relationship between MRTFA mRNA expression and clinical characteristics in ovarian cancer tissues was analyzed. The ovarian cancer SKOV3 cells were cultured and grouped, and the proliferation activity of ovarian cancer SKOV3 cells was detected by MTT. The invasive ability of SKOV3 cells was determined by Transwell method, and the expression of MRTFA protein in SKOV3 cells was determined by Western blot.Results:The relative expression of MRTFA mRNA in ovarian cancer tissues was significantly higher than that in adjacent tissues ( P<0.05) . The relative expression of MRTFA mRNA in ovarian cancer tissues with tumor diameter <10 cm, FIGO stage I-II stage, moderately high differentiation and no lymph node metastasis was lower than that with tumor diameter≥10cm, FIGO stage III-IV stage, poor differentiation, lymph node metastasis in patients with ovarian cancer ( P<0.05) . The absorbance values of ovarian cancer SKOV3 cells in MRTFA intervention group were lower than those in the control group and the negative control group at 24 h, 48 h, 72 h and 96 h ( P<0.05) . Conclusions:The expression of MRTFA is abnormally increased in ovarian cancer. The specific inhibition of MRTFA protein expression can block the proliferation and invasion of SKOV3 cells. The mechanism of action may be related to the transformation process of SRF induced epithelial mesenchyme.

The current document is based on a consensus reached by a panel of experts from the Chinese Society of Allergy and the Chinese Society of Otorhinolaryngology-Head and Neck Surgery, Rhinology Group. Chronic rhinosinusitis (CRS) affects approximately 8% of Chinese adults. The inflammatory and remodeling mechanisms of CRS in the Chinese population differ from those observed in the populations of European descent. Recently, precision medicine has been used to treat inflammation by targeting key biomarkers that are involved in the process. However, there are no CRS guidelines or a consensus available from China that can be shared with the international academia. The guidelines presented in this paper cover the epidemiology, economic burden, genetics and epigenetics, mechanisms, phenotypes and endotypes, diagnosis and differential diagnosis, management, and the current status of CRS in China. These guidelines—with a focus on China—will improve the abilities of clinical and medical staff during the treatment of CRS. Additionally, they will help international agencies in improving the verification of CRS endotypes, mapping of eosinophilic shifts, the identification of suitable biomarkers for endotyping, and predicting responses to therapies. In conclusion, these guidelines will help select therapies, such as pharmacotherapy, surgical approaches and innovative biotherapeutics, which are tailored to each of the individual CRS endotypes.
Adult ; Asian Continental Ancestry Group ; Biomarkers ; China ; Consensus ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Eosinophils ; Epidemiology ; Epigenomics ; Genetics ; Humans ; Hypersensitivity ; Inflammation ; International Agencies ; Medical Staff ; Neck ; Phenotype ; Precision Medicine

Allergic rhinitis (AR) is a global health problem that causes major illnesses and disabilities worldwide. Epidemiologic studies have demonstrated that the prevalence of AR has increased progressively over the last few decades in more developed countries and currently affects up to 40% of the population worldwide. Likewise, a rising trend of AR has also been observed over the last 2–3 decades in developing countries including China, with the prevalence of AR varying widely in these countries. A survey of self-reported AR over a 6-year period in the general Chinese adult population reported that the standardized prevalence of adult AR increased from 11.1% in 2005 to 17.6% in 2011. An increasing number of original articles and imporclinical trials on the epidemiology, pathophysiologic mechanisms, diagnosis, management and comorbidities of AR in Chinese subjects have been published in international peer-reviewed journals over the past 2 decades, and substantially added to our understanding of this disease as a global problem. Although guidelines for the diagnosis and treatment of AR in Chinese subjects have also been published, they have not been translated into English and therefore not generally accessible for reference to non-Chinese speaking international medical communities. Moreover, methods for the diagnosis and treatment of AR in China have not been standardized entirely and some patients are still treated according to regional preferences. Thus, the present guidelines have been developed by the Chinese Society of Allergy to be accessible to both national and international medical communities involved in the management of AR patients. These guidelines have been prepared in line with existing international guidelines to provide evidence-based recommendations for the diagnosis and management of AR in China.
Adult ; Asian Continental Ancestry Group* ; China ; Comorbidity ; Developed Countries ; Developing Countries ; Diagnosis* ; Epidemiologic Studies ; Epidemiology ; Global Health ; Humans ; Hypersensitivity* ; Prevalence ; Rhinitis, Allergic*

Objective To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM).Methods This was a 26-week,randomized,open-label,parallel-group,treat-to-target trial in 560 Chinese subjects with T2DM (men/women:274/263,mean age 56 years,mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs).Subjects were randomized 2:1 to once-daily IDeg (373 subjects) or IGlar(187 subjects),both in combination with metformin.The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks.Results Mean HbA1c decreased from 8.2％ in both groups to 6.9％ in IDeg and 7.0％ in IGlar,respectively.Estimated treatment difference (ETD) of IDegIGlar in change from baseline was-0.10％ points (95％ CI-0.25-0.05).The proportion of subjects achieving HbA1c ＜ 7.0％ was 56.3％ and 49.7％ with IDeg and IGlar,respectively [estimated odds ratio of IDeg/IGlar:1.26 (95 ％ CI 0.88-1.82)].Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar,respectively [estimated rateratio of IDeg/IGlar 0.69 (95％ CI 0.46-1.03),and 0.43 (95％ CI 0.19-0.97)].No differences in other safety parameters were found between the two groups.Conclusions IDeg was non-inferior to IGlar in terms of glycaemic control,and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia.IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment.Clinical trail registration Clinicaltrials.gov,NCT01849289.

Objective To investigate changes in the firing activities of nucleus accumbens (NAc)neurons and their response to 5-HT7 receptor stimulation in a rat model of Parkinson’s disease (PD).Methods The firing activities and response of NAc neurons to 5-HT7 receptor agonist in PD rats were recorded by in vivo electroneurophysiology and neuropharmacology and then were compared with those in the sham group.Results The mean firing rate of NAc neurons was (5.46 ±0.88)Hz in the sham rats and (3.77 ±0.48)Hz in the PD rats. The firing rate of NAc neurons increased significantly compared with that in the sham rats (P <0.05).In PD rats, 65% of NAc neurons fired in bursts and 35% fired irregularly.However,in the sham rats,57.5% of NAc neurons fired in bursts and 42.5% fired irregularly.There was no significant difference in the firing pattern of NAc neurons between the PD and sham rats (P >0.05 ).Systemic administration of 5-HT7 receptor agonist AS1 9 increased the firing rate of NAc neurons in the sham and PD rats.This excitation was significant at a high dose of 1 60 μg/kg for NAc neurons in the sham rats (P <0.05).However,the excitation produced by AS1 9 was significant at a high dose of 80 μg/kg in PD rats (P <0.05).The cumulative dose-produced excitation in the PD rats was lower than that in the sham rats.The effects induced by AS1 9 were reversed by the 5-HT7 receptor antagonist SB269970 in both groups.Conclusion The reinforced firing activity of NAc neurons might be mediated by 5-HT7 receptor in the neurons of PD rats.