Objective To investigate the causal association between hip circumference (HC) and type 2 diabetes mellitus (T2DM) based on Mendelian randomization. Methods The genetic variants data of the HC and T2DM from the Genetic Investigation of Anthropometric Traits (GIANT) and DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) database were matched according to the single nucleotide polymorphism (SNP) rsID. Genetic loci strongly related to the HC were used as instrumental variables; and the inverse-variance weighting, MR-Egger regression model and weighting median method were carried out to analyze the causal effect of HC on T2DM. Results Fifty-two, nine and fifteen SNPs were matched in the total cohort, female cohort and male cohort, respectively. Heterogeneity test suggested the SNPs were homogeneous. We found HC to be positively associated with T2DM risk (OR=1.065, 95% CI: 1.030-1.100, OR=1.103, 95% CI: 1.057-1.150 and OR=1.583, 95% CI: 1.273-1.968, respectively) in above three cohorts, respectively. Sensitivity analysis showed the results were robust. Conclusions There is a relationship between HC and T2DM of people, and HC may be the risk factor of T2DM.

Fournier gangrene is a relatively rare clinical critical disease, and its clinical symptoms are not specific and easily unrecognized by some clinicians. It has the features of acute onset, quick development, severe illness, and often accompanied by infection shock which is seriously life-threatening. It is difficult in treatment with high medical costs and long length of hospitalization, which increases pain for patients and relatives and brings heavy economic and psychological burden on patients, society, and medical workers. By reviewing the literature home and abroad and combined with clinical practice, I summarize the researches on concept, epidemiology, clinical manifestation, diagnosis and treatment of Fournier gangrene, in order to provide reference for vast number of clinical workers.

Objective To investigate the incidence of central line-associated bloodstream infection (CLABSI) in patients with hematopoietic stem cell transplantation (HSCT), explore risk factors for the occurrence of CLABSI.Methods Basic information of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who underwent HSCT in a hematology department from November 1, 2016 to October 31, 2017 was collected, incidences of original CLABSI (OCLABSI) and modified CLABSI (MCLABSI) were calculated, related risk factors were analyzed by multivariate Cox regression.Results A total of 218 patients with AML and MDS who underwent HSCT were enrolled, 19 of whom had OCLABSI and 10 had MCLABSI.Twenty-one strains of pathogens were isolated from 19 patients with OCLABSI, including 9 gram-positive bacteria, 11 gram-negative bacteria, 1 fungus;9 strains were multidrug-resistant organisms.The main risk factors for OCLABSI included the female (HR=0.088;95％CI:0.017-0.440;P=0.003), age (HR=1.560;95％CI:1.066-2.530;P=0.034), bone marrow cell transplantation only (HR=4.408;95％CI:1.860-22.593;P=0.043), ATG/CSA/MMF/MTXG for preventing graft-versus-host disease (GVHD) (HR=0.101;95％CI:0.015-0.686;P=0.019), and MTX for preventing GVHD (HR=0.097;95％CI:0.011-0.816;P=0.032).Conclusion Definition of MCLABSI can provide more accurate monitoring on deep central venous catheter-related bloodstream infection.Incidence of CLABSI in HSCT patients can be reduced by early detection of high-risk population according to high-risk factors, strict adherence to the prevention and control measures of bloodstream infection, and implementation of immune recombination after enhanced transplantation.

Objective To investigate the efficacy of domestic porcine antihuman lymphocyte immunoglobulin (p-ALG) in the treatment of severe aplastic anemia (SAA) with allogeneic hemopoietic stem cell transplantation (HSCT). Methods The clinical data of 5 SAA patients who received allogeneic HSCT from January 2015 to May 2018 were retrospectively analyzed. The conditioning regimen included p-ALG + cyclophosphamide + fludarabine. The method of peripheral stem cell and bone marrow blood was used in allogeneic HSCT (the total amount of bone marrow blood was less than 400 ml and the puncture point was not replaced). The p-ALG related complications, post-transplantation hemopoietic stem cell reconstitution time and efficacy were recorded. Results Allergic reaction occurred in 1 patient when using p-ALG, and there was no serum reaction. Hemopoietic reconstitution was achieved in all the 5 patients. The time for neutrophilic granulocyte > 0.5 × 109/L was 11 to 17 d, and the time for platelet count > 20 × 109/L was 11 to 15 d after transplantation. The results of short-strand repeat polymerase chain reaction assays showed all complete donor chimera. Graft versus host disease occurred in 3 cases, and was successfully controlled by methylprednisolone and tacrolimus. The time for stopping red blood cell transfusion was 9 to 87 d. The patients were followed up for 1 to 37 months, and the patients all survived well. Conclusions The efficacy of p-ALG in SAA patients of allogeneic HSCT is affirmative, and the cost is obviously reduced. It is worthy of clinical use.

Objective To investigate the effects of cyclinA2 and its inhibitor p21 on alveolar development in bronchopulmonary dysplasia (BPD) neonatal rats.Methods Eighty newborn rats were randomly divided into a model group (FiO2 =80％-85％) and a control group (FiO2 =21％).The degree of alveolar development was evaluated by radial alveolar count (RAC) and alveolar septal thickness.The distribution and expression of cyclinA2 and p21 were detected by immunohistochemistry and Western blot.Results The RAC value of the model group was lower than that of the control group from 3 days.The thickness of the alveolar seprum was higher than that of the control group from 7 days (P ＜0.05).The expression of p21 protein in the model group began to increase from 3d,peaked on 14d,and lasted for 21d.The expression of cyclinA2 protein in model group was higher than that in control group at 14d and 21d (P ＜0.05).There was a negative correlation between RAC and p21 protein expression in model group (r =-0.5966,P ＜0.01),and no correlation with cyclinA2 (r=0.7276,P＞0.05);there was no correlation between RAC and p21 in the control group (r =-0.2929,P ＞ 0.05),and positively correlated with cyclinA2 (r =0.8476,P ＜ 0.01).The alveolar septal thickness of the model group and the control group were both positively correlated with p 21 (r =0.4291,P＜0.05;r=0.4447,P ＜0.05),and negatively correlated with cyclinA2 (r=-0.6814,P ＜0.01;r=-0.7636,P ＜0.01).Conclusion The imbalance of cell cycle regulatory protein cyclinA2 and its inhibitor p21 expression in neonatal rats exposed to hyperoxia may be one of the related factors that interfere with the development of BPD alveoli.

OBJECTIVE: To explore the relationship between the expression levels of JARID1B,Hes1 and MMP-9 genes and the stages of chronic myelogenous leukemia(CML) and the curative effect of imatinib mesylate (IM). METHODS: Peripheral blood samples of 15 cases of CML in chronic phase and 10 cases of CML in progressive phase were collected from the Hematology Department of Taihe Hospital affiliated to Hubei University of Medicine and 15 cases of healthy people in the Physical Examination Center. CML patients were divided into effective group and ineffective group based on the efficacy after treatment with IM, then real-time PCR was used to detect the expression levels of JARID1B, Hes1 and MMP-9 mRNA, finally, the differences in the level of gene expression and their correlations with CML stages and IM curative efficacy were analysed. RESULTS: The expression levels of Hes1 and MMP-9 in initially diagnosed patients in chronic and progressive phase without IM treatment were significantly higher than those of health people（P＜0.05）. There was no significant difference in the expression level of JARID1B between chronic phase patients and health people（P＞0.05）, but the expression level of JARID1B in the progressive phase patients was higher than that of health people （P＜0.05）. The expression levels of JARID1B and Hes1 in the IM-effective group were not significantly different from those in the IM-ineffective group (P=0.85,P=0.82）, while the expression level of MMP-9 in the IM-effective group [JP2]was significantly lower than that in the IM-ineffective group（P＜0.05）. CONCLUSION The expression levels of JARID1B Hes1 and MMP-9 relate with the different phase of CML; The expression levels of JARID1B and Hes1 have not significant relationship with IM curative efficacy, the MMP-9 gene expression level relates with IM curative efficacy.
Antineoplastic Agents ; therapeutic use ; Humans ; Imatinib Mesylate ; therapeutic use ; Jumonji Domain-Containing Histone Demethylases ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; drug therapy ; Matrix Metalloproteinase 9 ; Nuclear Proteins ; Repressor Proteins ; Transcription Factor HES-1

Epimedii Folium,a commonly used traditional Chinese medicine,has the effect of tonifying kidney Yang,strengthening bones and treating rheumatism. However,in recent years,the number of reports on adverse reactions of Epimedii Folium and its Chinese patent medicines such as Xianling Gubao Capsules and Zhuanggu Guanjie Pills has been gradually increased,and the toxicity of Epimedii Folium has attracted more and more attention. In this article,the ancient and modern literature on Epimedii Folium was traced through a comprehensive and systematic literature analysis method. According to the 2015 edition of the Chinese Pharmacopoeia,Epimedii Folium refers to the dried leaves of Epimedii Folium brevicomu,E. sugittutum,E. pubescens or E. koreuuum. The Chinese Pharmacopoeia also includes E. wushanense of Wushan Epimedium,which is the same plant variety as Epimedium. The study showed that there were differences in the geographical distribution,composition and toxicity among five species of Epimedium. This paper also explained the toxicity mechanism as well as efficacy enhancing and toxicity reducing effects of Epimedii Folium,and reported its related adverse reaction cases. Through a retrospective comparative study on the toxicity of the modern Chinese patent medicines Xianling Gubao Capsules and Zhuanggu Guanjie Pills containing Epimedii Folium,it was believed that Epimedii Folium had cardiovascular system toxicity,neurotoxicity,hepatotoxicity,long-term toxicity,acute toxicity,genotoxicity and special toxicity; its safe medication factors included patient syndrome,doctor factors,drug factors,processing and compatibility factors. Meanwhile,strategies were proposed to improve patient safety medication awareness,standardize Epimedii Folium varieties and quality supervision,and the toxicity of Epimedii Folium was studied,hoping to draw attention from scholars to the safety of Epimedii Folium,improve the safe use of Epimedii Folium,and prevent adverse reactions.
Drugs, Chinese Herbal ; adverse effects ; Epimedium ; chemistry ; Humans ; Medicine, Chinese Traditional ; Plant Leaves ; chemistry ; Retrospective Studies

OBJECTIVE: Identification of new risk factors is needed to improve prediction of adverse outcomes in patients with three-vessel disease (TVD). The present study aimed to evaluate the prognostic values of serum chloride and sodium levels in patients with TVD. METHODS: We used data from a prospective cohort of consecutive patients with angiographically confirmed TVD. The primary endpoint was all-cause death. Cox proportional hazard regression was used to analyze the relationship of serum chloride and sodium levels with long-term outcomes of TVD patients. RESULTS: A total of 8,318 participants with available serum chloride and sodium data were included in this analysis. At baseline, patients in the low tertiles group of serum chloride level (⪕ 102.0 mmol/L) or serum sodium level (⪕ 139.0 mmol/L) had more severe disease conditions. During a median follow-up of 7.5-year, both low serum chloride level and low serum sodium level were found to be associated with an increased risk for mortality in univariate analysis. However, when both parameters were incorporated into a multivariate model, only low serum sodium level remained to be an independent predictor of all-cause death (hazard ratio: 1.16, 95% confidence interval: 1.01-1.34, P = 0.041). Modest but significant improvement of discrimination was observed after incorporating serum sodium level into the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery score. CONCLUSION Serum sodium level is more strongly associated with long-term outcomes of TVD patients compared with serum chloride level. Low serum sodium level is an independent risk factor for mortality, but only provides modest prognostic information beyond an established risk model.
Aged ; China ; epidemiology ; Chlorides ; blood ; Coronary Artery Disease ; blood ; diagnosis ; mortality ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Prospective Studies ; Sodium ; blood

Objective To explore the expressions of Sry-related high mobility group box 9(SOX9)and gastrokine-1(GKN1) in gastric cancer tissues and their relationships with clinicopathologic features and prognosis of patients.Methods Immunohistochemistry was used to detect the expressions of SOX9 and GKN1 in 70 cases of gastric cancer tissues and corresponding paracancerous tissues including 27 cases of intestinal metaplasia and 43 cases of normal gastric mucosa. The relationships of SOX9 and GKN1 expressions with clinicopathological features and prognosis were analyzed in gastric cancer tissues.Results The high expression rates of SOX9 in gastric cancer tissues,intestinal metaplasia,and normal gastric mucosa were 92.9%(65/70),77.8%(21/27),and 55.8%(24/43),respectively(=21.722,<0.001). Positive nuclear and cytoplasmic staining was observed. The high nuclear expression rate of SOX9 in gastric cancer tissues was 67.1%,which was significantly higher than those of intestinal metaplasia(37.0%,=0.007)and normal gastric mucosa(23.3%,<0.001). The high cytoplasmic expression rate of GKN1 in normal gastric mucosa was 76.7%,which was significantly higher than those of intestinal metaplasia(44.4%,=0.006)and gastric cancer tissues(37.1%,<0.001). Univariate analysis demonstrated that the nuclear expression of SOX9 in gastric cancer was associated with the degree of tissue differentiation(=0.007),while the cytoplasmic expression of GKN1 was associated with both the degree of tissue differentiation(=0.002)and whether the pathological type was a signet-ring cell carcinoma(=0.009). Furthermore,the nuclear expression of SOX9 was negatively correlated with the expression of GKN1 in gastric cancer(=15.424,<0.001). The 5-year survival rates of patients with high or low nuclear expression of SOX9 were 33.8% and 67.5%,respectively(=0.016).The 5-year survival rates of patients with high or low expression of GKN1 were 60.0% and 35.6%,respectively(=0.044). Further research indicated that 5-year survival rate of patients with high nuclear expression of SOX9 and low expression of GKN1 was 28.8%. Cox multivariate regression analysis showed that TNM stage(stage Ⅱ:=7.435,95%:1.313-42.096,=0.023;stage Ⅲ:=12.214,95%:2.677-55.721,=0.001)and nuclear expression level of SOX9(=3.297,95%:1.199-9.065,=0.021)were independent risk factors for the prognosis of gastric cancer patients.Conclusions Changes in the expressions of SOX9 and GKN1 may be associated with the malignant biological behavior of gastric cancer. SOX9 may be a potential prognostic factor. The combined detection of SOX9 and GKN1 expression and the further study of their molecular mechanism may provide new clues for early diagnosis,targeted therapy,and prognostic prediction of gastric cancer.
Humans ; Immunohistochemistry ; Peptide Hormones ; genetics ; Prognosis ; SOX9 Transcription Factor ; genetics ; Stomach Neoplasms ; diagnosis ; genetics ; Survival Rate

In order to solve the problem of long-term (>9 months) efficacy in the treatment of Alzheimer's disease (AD) by conventional therapy (CT), a staged and multiply-targeted sequential therapy based on the evolvement of patterns (STEP) was developed. Its main innovations include: (1) the time order of evolution of patterns defined by Chinese medicine (CM) in AD was found, that is, "the orderly pattern evolution starting from Shen (Kidney) deficiency, progressing to phlegm, stasis and fire, and worsening to severe toxin as well as functional collapse"; (2) the cascade hypothesis of Shen deficiency in AD and its sequential therapy based on Shen-reinforcing was proposed, that is, "reinforcing Shen in the early stage and throughout the whole process, resolving phlegm, activating blood and purging fire in the middle stage, detoxifying and replenishing vitality to stop the collapse in the advanced stage", and through meta-analysis, clinical drug use was optimized, thus the leap from "inferential selection" to "evidence-based selection" was realized; (3) the STEP regimen combined with CT maintained cognitive and behavioral stability in AD patients for at least 12 months, with cognitive enhancement and behavioral synergy after 9 months, and cognitive benefit was superior to CT at 9, 12, 15, 18, 21, and 24 months, respectively. The 2-year cognitive improvement rate was increased by 25.64% (P=0.020) and the cognitive deterioration rate was decreased by 48.71% (P=0.000). Among them, the cognitive and functional benefits of Shen-reinforcing therapy for very early AD (350 cases) for 1 year were better than the placebo (P<0.001), and the dementia conversion rate was reduced by 8.85% (P=0.002). The behavioral symptomatic relief of patients with vascular dementia received fire-purging therapy (540 cases) was superior to those received CT (P=0.016). These data suggested that the STEP regimen has synergistic effects on CTs at least in terms of cognitive benefit, and the earlier the use, the greater the benefit will have. Therefore, the STEP regimen should be considered as one of the clinical options, particularly for the dearth of effective pharmaceutical or immunological interventions that are currently available for AD.