Poor ovarian response (POR) is a pathological condition in which the ovary responds poorly to gonadotropins,and is a major constraint on the unsatisfactory outcome of in vitro fertilization-embryo transfer (IVF-ET). Follicular growth,development,maturation,and expulsion are all affected by the yin-yang balance between heart and kidney,as well as the elevation exchange. If the heart and kidney essence and blood are insufficient,water and fire are out of harmony,and qi movement is not smooth,fewer high-quality follicles will be recruited and acquired during the ovarian stimulation cycle,resulting in a low transferable embryo rate and unacceptable pregnancy result. Sympathetic treatment of heart and kidney should be based on the following principles at different stages of the IVF-ET cycle:replenishing the heart,kidney,essence,and blood before entering the cycle,in order to nourish the essence and assist in the growth of the follicles;nourishing renal water,and clearing heart fire during the pituitary down-regulation period,in order to lessen the negative effects of the down-regulation medicinals;regulating the depression of the heart,liver,spleen,and kidney meridians during the follicle's retrieval period,in order to encourage the smooth release of the ova;and warming heart and kidney fire to improve endometrial tolerance during the implantation period. The application of the theory of intercourse of heart and kidney to elucidate the pathogenesis of POR is critical to the development of clinical strategies for fertility enhancement,as well as providing new ideas for the clinical application of traditional Chinese medicine in the field of reproduction.

Although primary vesical calculi is an ancient disease, the mechanism of calculi formation remains unclear. In this study, we established a novel primary vesical calculi model with d,l-choline tartrate in mice. Compared with commonly used melamine and ethylene glycol models, our model was the only approach that induced vesical calculi without causing kidney injury. Previous studies suggest that proteins in the daily diet are the main contributors to the prevention of vesical calculi, yet the effect of fat is overlooked. To assay the relationship of dietary fat with the formation of primary vesical calculi, d,l-choline tartrate-treated mice were fed a high-fat, low-fat, or normal-fat diet. Genetic changes in the mouse bladder were detected with transcriptome analysis. A high-fat diet remarkably reduced the morbidity of primary vesical calculi. Higher fatty acid levels in serum and urine were observed in the high-fat diet group, and more intact epithelia in bladder were observed in the same group compared with the normal- and low-fat diet groups, suggesting the protective effect of fatty acids on bladder epithelia to maintain its normal histological structure. Transcriptome analysis revealed that the macrophage differentiation-related gene C-X-C motif chemokine ligand 14 (Cxcl14) was upregulated in the bladders of high-fat diet-fed mice compared with those of normal- or low-fat diet-fed mice, which was consistent with histological observations. The expression of CXCL14 significantly increased in the bladder in the high-fat diet group. CXCL14 enhanced the recruitment of macrophages to the crystal nucleus and induced the transformation of M2 macrophages, which led to phagocytosis of budding crystals and prevented accumulation of calculi. In human bladder epithelia (HCV-29) cells, high fatty acid supplementation significantly increased the expression of CXCL14. Dietary fat is essential for the maintenance of physiological functions of the bladder and for the prevention of primary vesical calculi, which provides new ideas for the reduction of morbidity of primary vesical calculi.

Objective:To observe the effect of Jieyu Anmian prescription of Chinese medicine foot bath on gastrointestinal function in patients with digestive system tumor during perioperative period.Methods:A total of 130 patients with digestive system tumors were chosen from January 2019 to March 2020 for the first time visits to the first hospital of lanzhou university for surgical treatment, 15 cases lost follow-up, and the rest 115 cases of patients were divided into the experimental group (59 cases) and the control group (56 cases) according to random number table method. The control group using conventional care method, the experimental group was treated with Jieyu Anmian washing formula on the basis of routine nursing care for 10 days. During the foot bath, the recovery of gastrointestinal function, the time of the first exhaust and defecation, the length of stay, the cost of stay and the satisfaction of patients were compared between the two groups.Results:The recovery time of bowel sounds, anal exhaust time and first defecation time of the experimental group were all earlier than those of the control group (16.21±11.81) h, (19.64±12.40) h and (41.98 ±19.16) h, respectively, while those of the control group were (27.34±31.47) h, (35.81±18.26) h and (34.47±16.41) h, respectively. The differences were statistically significant ( t value was -2.41, -5.33, 2.17, P< 0.05). The results of the survey of patient satisfaction showed that the experimental group was superior to the control group, with 97.47 ± 4.37 in the experimental group and 94.19 ± 3.29 in the control group, with statistically significant differences ( t value was 3.89, P<0.01). The satisfaction of doctors in the experimental group was 97.41 ± 6.25 and 94.21±5.91 in the control group, with statistically significant difference ( t value was 3.95, P<0.05). The satisfaction of nurses in the experimental group was 97.58 ± 4.53 and 93.85±5.23 in the control group, and the difference was statistically significant ( t value was 4.12, P<0.05). There was no significant difference between the two groups in terms of length of stay and hospitalization expenses ( P>0.05). Conclusions:Jieyuanmian prescription of Chinese medicine foot bath can promote the recovery of gastrointestinal function, promote the exhaust and defecation, and improve the satisfaction of patients and nurses.

Objective To evaluate the application effect of nursing management in the follow-up of patients with recurrent acute pancreatitis (RAP).Methods During January 2016 and January 2017,the clinical data of RAP patients admitted in Changhai Hospital of Navy Medical University was collected.Selfcontrol method was used to establish a prospective cohort study.Meticulous nursing management mode was applied to follow up the patients for 12 months.Patients' compliance,symptom improvement,patients' satisfaction and other markers are evaluated using questionnaires to assess the effect of meticulous nursing management once every 3 months.The data over 12 months were collected.Results Sixty-four RAP patients were finally included.The average follow-up period was 19.7 ±3.4 months.Before admission,the average disease course was(4.21 ± 3.95) years.30 patients (46.9％)had a history of drinking;33 patients (51.6％)had a history of smoking.25 patients (39.1％) had abnormal blood lipid and 40 patients (62.5％) had the dietary habit of high lipid and high protein.The etiology included alcohol (n =10,15.6％),high lipid (n =7,10.9％),biliary diseases (n =1,1.6％),idiopathic causes (n =46,71.9％) and abnormal BMI (n =49,76.6％).After the meticulous nursing management,the frequency of pancreatitis,VAS score of pain and alcohol intake situation was obviously lower than before intervention [(0.50 ±0.85) times/year vs(2.77 ±2.52)times/year;(1.84 ±2.54)vs(6.47 ±2.15);2 cases vs 30 cases].The number of patients who took medicine on time and BMI were obviously decreased[(52 cases vs 13 cases;(23.26 ± 3.85) kg/m2 vs (21.92 ± 4.27)kg/m2)],and the differences were statistically significant (P ＜0.01).Patients' satisfaction with this nursing model was 4.90 ± 0.56.Conclusions The implementation of the new meticulous nursing management model can effectively alleviate patient's symptom condition and improve the compliance behavior and life quality of the patients.

This paper rounded up the resources and advantages leveraged by the hospital′s burn and plastic surgery department as a national key discipline. The department practiced medical services for chronic wounds in the regional hierarchical medical system for chronic wounds to promote the development medical alliances. IT development of the hierarchical medical network has achieved disease information sharing, namely centralized patients screening, patients referral confirmation, mutual recognition of test results, online consultation and treatment follow-up. Other achievements include standardization of medical criteria for chronic wounds by means of effective integration of resources imbalance within the network and improvement of internal medical regulations; elevation of primary level innovation capacity and services by means of high-caliber specialists working at primary institutions and mutual exchanges in between; effective medical cost control via guarantee system building, thus enhancing the public benefit nature of public hospitals. The paper also probed into problems and solutions expected in the way of promoting the chronic wound hierarchical medical system.

Objective To explore the relationship between sudomotor function and peripheral artery disease (PAD),and to evaluate the effectiveness of sudomotor function testing to screen diabetic patients at high risk of PAD comparing to ankle-brachial index (ABI) and toe-brachial index (TBI).Methods A total of 263 diabetes mellitus (DM) outpatients in the 306th Hospital of PLA from August 2014 to April 2015 were enrolled in the study.ABI and TBI were measured by the Doppler method.Sudomotor function was evaluated by measuring the electrochemical skin conductance (ESC) of the hands and feet using the Sudoscan instrument.Cardiovascular autonomic neuropathy (CAN) was assessed and recorded as cardiac autonomic neuropathy risk-score (CAN-RS) by Sudoscan.Results ESC values of the feet and hands were positively correlated with ABI and TBI.The diabetes patients with abnornal ABI and TBI had significantly lower hand ESC [(45.63±12.87) μS vs.(68.10±17.40) μS,(59.17±19.58) μS vs.(68.57±17.11) μS;P＜ 0.05] and feet ESC [(44.54±25.48) μS vs.(70.92±19.46) μS,(59.21±24.52) μS vs.(71.71±19.02) μS;P＜ 0.05],and higher CAN-RS[(49.17± 15.41)％ vs.(36.33±16.25)％,(44.90±16.09)％ vs.(35.39±16.05)％;P＜ 0.05],than diabetes patients with normal ABI and TBI.Using ABI as the gold standard,the areas under the receiver operating characteristics (ROC) curve of the diagnostic performance of hands ESC,feet ESC and CAN-RS to identify PAD were 0.87,0.84 and 0.74,respectively (P＜0.001).Conclusion Sudomotor function testing can be helpful and beneficial to identify PAD in patients with diabetes.

Objective To analyze the related risk factors for Lisfranc injury resulting from low energy violence.Methods A retrospective study was performed for 61 cases (35 males,26 females) with low-energy foot injury hospitalized from June 2008 to June 2014.Mean age was 36.7 years (range,16-57 years).Fall injuries were noted in 24 cases,sports injuries in 21 cases,and twist injuries in 16 cases.The cases were divided into Lisfranc injury group(n =23) and non-Lisfranc injury group (n =38) according to the different diagnosis.Univariate analysis and multi-factor logistic regression analysis were used to identify the factors that may lead to the occurrence of Lisfranc injury including age,gender,body mass index,operation history,smoking,alcohol abuse,injury reason,medial depth of the mortise/ second metatarsal length (b/a),lateral depth of the mortise/ second metatarsal length (c/a),first metatarsal-to-talus angle,first intermetatarsal angle,second metatarsal length/foot length(a/g),calcaneal inclination angle and cuboid-navicular overlap/cuboid vertical height (e/e + f).Results Univariate analysis showed between-group differences were significant in age (x2 =7.385,P ＜0.05),injury reason (x2 =8.663,P ＜ 0.05),calcaneal inclination angle (t =3.958,P ＜ 0.05),b/a (t =5.051,P ＜ 0.05) and a/g(t =4.618,P ＜ 0.05).Logistic regression analysis identified b/a(OR =1.036,95 ％ CI 0.018-0.450,P ＜ 0.01) and a/g(OR =1.013,95％ CI 0.005-0.374,P ＜ 0.01) as independent risk factors for low-energy Lisfranc injury.Conclusion Low-energy Lisfranc injury is independently associated with b/a and a/g,and may relate to the decreased medial depth of the mortise and increased foot length.

Objective To explore the functions of neuron‐specific enolase(NSE) and human multiple myeloma U266 cells on osteoclast‐like cells(OLC) function .Methods Normal human peripheral blood mononuclear cells were induced and cultured by adding RANKL and M‐CSF to get OLC ;the experiment was divided into 3 groups ,the NSE group:OLC were cultured in the 6‐well culture plate for 14 d and added with 100 ng/mL recombinant human NSE to culture for 24 ,48 ,72 h;the co‐culture group:OLC were cultured in the lower well of 6‐well Transwell chamber for 14 d ,then added with 1 × 105/well U266 cells in each upper well and conducted the co‐culture for 24 ,48 ,72 h;the control group :OLC were cultured alone .The influences of NSE and U266 cell line on RANKL ,OPG ,IL‐6 and TRAP mRNA transcriptional level of OLS were compared by using real‐time fluorescent quantitative PCR .Results RANKL ,OPG ,IL‐6 mRNA had no expression on OLC in the co‐culture group ,NSE group and control group ;com‐pared with control group ,the TRAP mRNA expression level in the co‐culture group and the NSE group was increased ,the differ‐ence was statistically significant(P<0 .01);the increase of TRAP mRNA expression level was obvious especially at 48 ,72 h .Con‐clusion OLC expressing TRAP and NSE may be one of the factors for promoting OLC differentiation and maturation in myeloma bone disease ,prompting that NSE could increase the OLC viability .

Aim ToobservetheeffectofSanHuang Decoction (SHD )on glucose and lipid metabolism in insulin resistance(IR)3T3-L1 adipocytes.Methods TheIRmodelof3T3-L1adipocyteswasinducedby high glucose and hyperinsulinism cultivation(also con-taining dexamethasone ).The adipocytes were treated with rosiglitazone(Ros)and different concentrations of SHD(2. 5,5,10,20,40 g·L-1 )for 24 h.The content of glucose disappeared from the culture medium was determined as glucose consumption of the cells. The transport of glucose was observed by 2-deoxidation-[3 H]-glucose uptake method.The efflux of nonesteri-fied fatty acids(NEFA)from adipocytes was observed by the concentration of NEFA in the culture medium. The mRNA expression of glucose transporter-4 (GLUT-4)was measured by real-time polymerase chain reac-tion (real-time PCR).The protein expression of GLUT-4wasdetectedbyWesternblot.Results Compared with the Con group,SHD(5,10,20,40 g·L-1 ) could significantly induce the glucose consumption and transportion(P<0. 01 ),increase the glycerol content in culture supernatant(P<0. 01 ),reduce the NEFA concentration in culture medium and accumulation of intracellular TG(P<0. 01 ).And all of these change showed a concentration-dependent effect when SFD concentrations were from 5 g·L-1 to 20 g·L-1 .At the same time,Ros could also remarkably induce the glucose consumption and transportion(P<0. 01 ),and increase the accumulation of intracellular TG (P <0. 01);but the concentration of NEFA and glycerol in culture medium did not show any difference in the Ros-treatedgroup(P>0.05).Conclusion SHDcanin-crease insulin sensitivity by increasing glucose trans-portation and consumption in the 3T3-L1 adipocytes as well as decreasing the NEFA efflux from the cells.

OBJECTIVETo evaluate the association between chemical exposure, DNA methylation status and gene-environment interactions in the development of childhood acute leukemia (AL).

METHODSFrom January 1st 2009 to December 31st 2010, an exploratory case-control study was conducted on childhood AL among children who were less than 15 years of age in Shanghai, China. A total of 131 patients with newly diagnosed AL were recruited from 3 Shanghai children hospitals. The controls selected from the same hospital were healthy children who attended the physical check-up held by the department of Children's Healthcare, or who visited the clinic of developmental pediatrics or orthopedics (excluding blood diseases and malignant tumors). 140 controls matched with cases in gender and age were included in this study. Chemical exposure were investigated by questionnaires, methylation specific polymerase chain reaction (MSP) was adopted to analyze the methylation or deletion status of 8 genes, and gene-environment interactions were analyzed by relative excess risk of interaction (RERI), attributable proportion of interaction (API) and synergy index (S).

RESULTSThere were 131 and 140 subjects in case and control group, who were aged (6.9 ± 3.8) and (6.9 ± 3.9) years old (t = 0.01, P = 0.911), respectively. After adjusting age and other potential confounding factors, chemical substances' exposure of children/mother/father were all significantly higher in cases than that in controls (Children: OR = 3.90, 95% CI: 1.69-9.02; Mother: OR = 2.71, 95% CI: 1.12-6.52; Father: OR = 1.91, 95% CI: 1.05-3.47). For the 8 genes analyzed, the methylation status of DAPK and PTEN and P73 in case group were significantly higher than that in control group (cases: 3.1% (4 cases), 16.0% (21 cases), 7.6% (10 cases); controls: 0.7% (1 case), 2.9% (4 cases), 0.7% (1 case); χ²: 7.11, 16.90, 11.38; P value: 0.029, 0.000, 0.003). The methylation status of P16 in case group was significantly lower than that in control group (cases: 3.8% (5 cases); controls: 8.6% (12 cases), χ² = 10.33, P = 0.007). The interactions of children chemical substances' exposure and 3 genes' (PTEN, P16 and P73) methylation status were probably existed after adjusted for confounding factors (PTEN: RERI = -7.01, API = -2.14, S = 0.24; P16: RERI = 4.08, API = 0.53, S = 2.59; P73: RERI = 4.32, API = 0.48, S = 2.19), we also found the potential interaction between maternal chemical substances' exposure and PTEN, P16 gene methylation status (PTEN: RERI = -1.30, API = -0.38, S = 0.65; P16: RERI = 1.70, API = 0.38, S = 1.97).

CONCLUSIONThe study suggested the strong combined effects of chemical substances exposure of children and abnormal methylation status were risk factors of childhood AL, and there existed different interaction between them, which may indicate the important role in the pathogenesis process of childhood AL.

Acute Disease ; Case-Control Studies ; Child ; Child, Preschool ; China ; DNA Methylation ; Environmental Exposure ; Female ; Gene-Environment Interaction ; Humans ; Leukemia ; epidemiology ; Maternal Exposure ; Polymerase Chain Reaction ; Risk Factors