Objective:To investigate the effects of catalpol(cat)on autophagy and apoptosis of alveolar epithelial cells in-duced by Streptococcus pneumoniae(SP)by regulating adenosine monophosphate-activated protein kinase(AMPK)/mammalian target of rapamycin(mTOR)/Unc-51-like kinase 1(ULK1)signaling pathway.Methods:Human alveolar epithelial cells A549 were divided into the following groups:control group,SP group(1×108 CFU/ml),cat low,medium,and high doses groups(0.5,1,2 μg/L),AICAR group(2 μg/L cat+1 mmol/L AMPK activator);CCK-8 method and flow cytometry were applied to detect cell proliferation and apoptosis,respectively;monodansylcadaverine(MDC)staining method was applied to detect autophagy in cells;ELISA was applied to detect the levels of IL-6,IL-1β and TNF-α in the cell supernatant;and Western blot was applied to detect the expressions of Bcl-2 associated X protein(Bax),anti apoptotic factor B cell lymphoblastoma 2(Bcl-2),Beclin-1,P62,microtubule-associated protein 1 light chain 3 Ⅰ(LC3 Ⅰ),microtubule-associated protein 1 light chain 3 Ⅱ(LC3 Ⅱ)and AMPK/mTOR/ULK1 pathway proteins in cells.Results:Compared with control group,the activity of A549 cells and the expression levels of Bcl-2,P62,p-mTOR/mTOR pro-teins in SP group were obviously reduced,the apoptosis rate,autophagy fluorescence intensity,levels of IL-6,IL-1β,TNF-α,the protein expression levels of Bax,LC3 Ⅱ/LC3 Ⅰ,Beclin-1,p-AMPK/AMPK,and p-ULK1/ULK1 were obviously increased(P<0.05);compared with the SP group,the activity of A549 cells and the expression levels of Bcl-2,P62,p-mTOR/mTOR proteins in the low,medium,and high dose cat groups were obviously increased,the apoptosis rate,autophagy fluorescence intensity,levels of IL-6,IL-1β,TNF-α,the protein expression levels of Bax,LC3 Ⅱ/LC3 Ⅰ,Beclin-1,p-AMPK/AMPK,and p-UKL1/UKL1 were ob-viously reduced(P<0.05);the AMPK activator AICAR weakened the inhibitory effect of cat on SP induced autophagy and apoptosis in A549 cells.Conclusion:cat can inhibit SP-induced autophagy and apoptosis in A549 cells,and its mechanism of action may be re-lated to regulating the AMPK/mTOR/ULK1 signaling pathway.

Objective:To investigate the effects of catalpol(cat)on autophagy and apoptosis of alveolar epithelial cells in-duced by Streptococcus pneumoniae(SP)by regulating adenosine monophosphate-activated protein kinase(AMPK)/mammalian target of rapamycin(mTOR)/Unc-51-like kinase 1(ULK1)signaling pathway.Methods:Human alveolar epithelial cells A549 were divided into the following groups:control group,SP group(1×108 CFU/ml),cat low,medium,and high doses groups(0.5,1,2 μg/L),AICAR group(2 μg/L cat+1 mmol/L AMPK activator);CCK-8 method and flow cytometry were applied to detect cell proliferation and apoptosis,respectively;monodansylcadaverine(MDC)staining method was applied to detect autophagy in cells;ELISA was applied to detect the levels of IL-6,IL-1β and TNF-α in the cell supernatant;and Western blot was applied to detect the expressions of Bcl-2 associated X protein(Bax),anti apoptotic factor B cell lymphoblastoma 2(Bcl-2),Beclin-1,P62,microtubule-associated protein 1 light chain 3 Ⅰ(LC3 Ⅰ),microtubule-associated protein 1 light chain 3 Ⅱ(LC3 Ⅱ)and AMPK/mTOR/ULK1 pathway proteins in cells.Results:Compared with control group,the activity of A549 cells and the expression levels of Bcl-2,P62,p-mTOR/mTOR pro-teins in SP group were obviously reduced,the apoptosis rate,autophagy fluorescence intensity,levels of IL-6,IL-1β,TNF-α,the protein expression levels of Bax,LC3 Ⅱ/LC3 Ⅰ,Beclin-1,p-AMPK/AMPK,and p-ULK1/ULK1 were obviously increased(P<0.05);compared with the SP group,the activity of A549 cells and the expression levels of Bcl-2,P62,p-mTOR/mTOR proteins in the low,medium,and high dose cat groups were obviously increased,the apoptosis rate,autophagy fluorescence intensity,levels of IL-6,IL-1β,TNF-α,the protein expression levels of Bax,LC3 Ⅱ/LC3 Ⅰ,Beclin-1,p-AMPK/AMPK,and p-UKL1/UKL1 were ob-viously reduced(P<0.05);the AMPK activator AICAR weakened the inhibitory effect of cat on SP induced autophagy and apoptosis in A549 cells.Conclusion:cat can inhibit SP-induced autophagy and apoptosis in A549 cells,and its mechanism of action may be re-lated to regulating the AMPK/mTOR/ULK1 signaling pathway.

Objective:To investigate the value of implantable cardiac monitor (ICM) in the diagnosis and treatment of patients over 60 years old with unexplained syncope.Methods:This was a multi-center, prospective cohort study. Between June 2018 and April 2021, patients over the age of 60 with unexplained syncope at Beijing Hospital, Fuwai Hospital, Beijing Anzhen Hospital and Puren Hospital were enrolled. Patients were divided into 2 groups based on their decision to receive ICM implantation (implantation group and conventional follow-up group). The endpoint was the recurrence of syncope and cardiogenic syncope as determined by positive cardiac arrhythmia events recorded at the ICM or diagnosed during routine follow-up. Kaplan‐Meier survival analysis was used to compare the differences of cumulative diagnostic rate between the 2 groups. A multivariate Cox regression analysis was performed to determine independent predictors of diagnosis of cardiogenic syncope in patients with unexplained syncope.Results:A total of 198 patients with unexplained syncope, aged (72.9±8.25) years, were followed for 558.0 (296.0,877.0) d, including 98 males (49.5%). There were 100 (50.5%) patients in the implantation group and 98 (49.5%) in the conventional follow-up group. Compared with conventional follow-up group, patients in the implantation group were older, more likely to have comorbidities, had a higher proportion of first degree atrioventricular block indicated by baseline electrocardiogram, and had a lower body mass index (all P<0.05). During the follow-up period, positive cardiac arrhythmia events were recorded in 58 (58.0%) patients in the ICM group. The diagnosis rate (42.0% (42/100) vs. 4.1% (4/98), P<0.001) and the intervention rate (37.0% (37/100) vs. 2.0% (2/98), P<0.001) of cardiogenic syncope in the implantation group were higher than those in the conventional follow-up group (all P<0.001). Kaplan-Meier survival analysis showed that the cumulative diagnostic rate of cardiogenic syncope was significantly higher in the implantation group than in the traditional follow-up group ( HR=11.66, 95% CI 6.49-20.98, log-rank P<0.001). Multivariate analysis indicated that ICM implantation, previous atrial fibrillation, diabetes mellitus or first degree atrioventricular block in baseline electrocardiogram were independent predictors for cardiogenic syncope (all P<0.05). Conclusions:ICM implantation improves the diagnosis and intervention rates in patients with unexplained syncope, and increases diagnostic efficiency in patients with unexplained syncope.

Objective To investigate the effects of dexmedetomidine on postoperative cognitive dysfunction (POCD) in patients with obstructive sleep apnea. Methods A total of 50 patients with obstructive sleep apnea were divided into 2 groups: a dexmedetomidine group and a control group. Dexmedetomidine and 0.9% saline solution were given before and during the operation in the dexmedetomidine group and the control group respectively. MMSE scores were estimated at different time, and the concentration of serum S100β and NSE were detected before anesthesia at 3 h, 6 h, 24 h and 48 h after operation. Results One day after surgery, MMES score decreased significantly in both groups,of which MMES was notably higher in the DEX group than that in the control group (P<0.05). In both groups, S100βand NSE levels were significantly higher at T2, T3 and T4 than those at T1, and were the highest at T3 (P<0.05). S100β and NSE levels were significantly lower in the DEX group than those in the control group (P<0.05). Conclusion Dexmedetomidine can reduce the incidence of POCD in patients with obstructive sleep apnea. Its mechanism may relate to neuroprotection.

Purpose To evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in papillary thyroid carcinomas (PTC) by exploring the relationship between quantitative parameters of time-intensity curve (TIC) of CEUS for PTC and tumor size and metastasis of cervical lymph nodes.Materials and Methods 124 patients with PTC confirmed by surgery and pathology in the Affiliated Hospital of Qingdao University were retrospectively analyzed.According to maximum diameter of lesions (D),the lesions were divided into three groups with D＜1.0 cm,1.0 cm ≤ D ≤ 2.0 cm and D＞2.0 cm.The lesions were also divided into LN(+) group with lymph node metastasis and LN(-) group without lymph node metastasis based on pathology of cervical lymph nodes.The features of CEUS and quantitative parameters of TIC of the above groups were analyzed.Results ① The CEUS showed that the PTC nodules were mainly concentric and heterogeneous enhancement.Thyroid carcinoma with D＜1.0 cm and 1.0 cm≤D≤2.0 cm showed low enhancement (45/57,31/42),while thyroid carcinomas with D＞2.0 cm exhibited high enhancement (14/25),and the difference was significant (P＜0.05).① With the increase of the diameter of PTC,the peak intensity [(12.75 ± 3.77)％,(15.53 ± 3.62)％,(18.11 ± 4.28)％],the area under the curve [(820.52±289.19)％.s,(873.84± 156.19)％· s,(1118.8± 152.48)％ ·s] and the ratio of the perfusion defects (24.56％,52.38％,72.00％) were increased,and the differences were statistically significant (P＜0.05).③ The cervical lymph node metastasis rate of PTCs with isoenhancement or hyperenhancement patterns showed by CEUS was significantly higher than that with hypoenhancement (P＜0.05).The peak intensity and the area under the curve of LN (+) group were higher than that of LN (-) group,and the differences were statistically significant (P＜0.05).Conclusion There were significant differences in imaging features of CEUS between the PTC nodules with different size and lymph node metastasis,which can provide valuable information for clinical diagnosis.

Objective To detect the changes of the NJ001 specific antigen expression before and after surgery, and evaluate whether the NJ001 specific antigen could be used as a serum biomarker for the diagnosis of pancreatic cancer.Methods With the method of sandwich ELISA, the serum samples from 85 pancreatic cancer patients, 22 pancreatic benign tumor and 40 healthy controls were detected respectively. The results of the NJ001 specific antigen in the serum samples from 85 pancreatic cancer patients were compared with CA19-9 detected by ECLIA.Results The positive rate of NJ001 for the pancreatic cancer group was obviously higher than that for the benign pancreatic tumor and health control groups[50.6%(43/85) vs 18.2%(4/22), χ2 =7.451, P<0.05; 50.6%(43/85) vs 10.0%(4/40), χ2 =19.098, P<0.05].The difference between benign pancreatic tumor group and health control group had no statistical significance[18.2%(4/22) vs 10.0%(4/40),χ2 =0.845, P>0.05].The positive rate in the group of pancreatic cancer before surgery was higher than that after surgery[50.6%(43/85) vs 23.5%(20/85),χ2=13.341, P<0.05].In addition, the results from 85 pancreatic cancer patients showed the specificity of NJ001 specific antigen was up to 87.1%.Although the positive rate of NJ001 specific antigen for pancreatic cancer was lower than that of CA19-9[50.6%(43/85) vs 75.3%(64/85), χ2 =11.121, P<0.05], it was higher when they combined [ 85.9%( 73/85 ) ] .Conclusions It shows high positive rate of NJ001 specific antigen in the patients of pancreatic cancer in this study, which suggests that NJ001 specific antigen might be a potential valuable biomarker for the diagnosis of pancreatic cancer.

Objective Plasma circulating DNA can be em-ployed in place of bone marrow examination for the auxiliary diagnosis of leukemia.This study aimed to explore the clinical application of the plasma DNA level in evaluating the effect of chemotherapy on chronic leukemia. Methods We collected blood samples from 52 patients with chronic myelogenous leukemia (CML) (33 in the chronic phase, 7 in the acceleration phase, and 12 in the blast phase) , 85 with chron-ic lymphocytic leukemia (CLL) (28 with complete remission, 27 with partial remission, and 30 with no remission), 4 patients with hairy cell leukemia (HCL), and 80 healthy subjects.We simultaneously obtained plasma DNA and recombinant plasmid DNA using the BI-LATEST DNA Kit and examined the human β-actin gene and the level of plasmid DNA by real-time quantitative PCR. Results Before chemotherapy, the median value of plasma DNA was 149.46(30.63-496.91)ng/ml in the CML and 101.54(69.10-258.14) ng/ml in the CLL patients, both significantly higher than in the healthy controls (19.05[12.67-25.92]ng/ml) (P<0.01).After chemotherapy, the plasma DNA level of the CML patients was remarkably decreased, but still higher than that of the controls ( P<0.01).The CML patients in the chronic phase showed a markedly higher level of plasma DNA (302.89[93.33-541.52]ng/ml) than those in the blast phase (43.19[23.54-70.03]ng/ml) and acceleration phase (28.11[16.21-92.07]ng/ml) (P<0.05).The CLL patients with CR exhibited a significantly lower level of plasma DNA (24.29[14.64-30.74]ng/ml) than those with PR (106.88 [96.23-143.25]ng/ml) and NR (460.73[284.57-653.38〗ng/ml) (P<0.01), but all dramatically higher than that of the healthy controls (P<0.01) Conclusion The quantification of plasma DNA has a clinical application value in evaluating the effect of chemo-therapy on chronic leukemia.