OBJECTIVES: To propose a hypothesis that aloe-emodin may inhibit scar tissue fibrosis through thrombospondin-1(THBS1)-PI3K-Akt pathway. METHODS: By cultivating fibroblasts derived from scar tissue after cleft palate surgery in humans, aloe emodin of different concentrations (10, 20, 30, 40 and 50 μmol/L) was added to the cells which activity was detected. At the same time, transcriptome sequencing was performed on scar tissue and cells, and bioinformatics methods were used to explore potential targets and signaling pathways of scar tissue fibrosis. RESULTS: Aloe-emodin had a concentration dependent inhibitory effect on fibroblast proliferation,with the 40 μmol/L concentration group showing the most significant effect. The results of tissue and cell sequencing indicated that differentially expressed genes were significantly enriched in extracellular matrix-receptor interaction pathway, and shared a common differential gene which was THBS1. The ORA analysis results indicated that differentially expressed genes, including THBS1, were significantly enriched in the PI3K-Akt signaling pathway. CONCLUSIONS Aloe emodin may inhibit the PI3K-Akt pathway by downregulating THBS1, thereby reducing the proliferation activity of fibroblasts derived from postoperative palatal scar tissue.
Thrombospondin 1/genetics* ; Humans ; Signal Transduction/drug effects* ; Fibroblasts/cytology* ; Proto-Oncogene Proteins c-akt/metabolism* ; Fibrosis ; Phosphatidylinositol 3-Kinases/metabolism* ; Cicatrix/metabolism* ; Cell Proliferation/drug effects* ; Anthraquinones/pharmacology* ; Cells, Cultured

Objective:To investigate the clinical efficacy of subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture in surgical treatment of benign pigmented facial lesions in infants and preschoolers.Methods:Totally, 100 infants and preschoolers with pigmented facial lesions were enrolled from the Department of Dermatology, Hanzhong Central Hospital and the Second Affiliated Hospital of Xi′an Jiaotong University from January 2018 to January 2019, and their clinical data were analyzed retrospectively. Among these patients, there were 59 males and 41 females, and their age ranged from 3 months to 5 years, with an average age of 15 months. All patients underwent outpatient surgery under local anesthesia, and sedative drugs were used before operation. The skin lesions were excised once or in stages according to their areas, and incisions were closed by using a subcutaneous asymmetric suture-based tension reduction technique, followed by dermal buried angular mattress sutures. After surgery, medical silicone gels and tension reduction devices were used for 6 months to 1 year, and postoperative follow-up was performed.Results:All patients were followed up for more than 1 year after surgery. Four patients showed suture rejection reaction within two months after surgery, and the incisions completely healed after the suture knots were discharged; cat′s ear-shaped scars were formed at the upper and lower ends of the incisions in 3 cases when the sutures were removed 1 week after surgery, no treatment was given, and the cat′s ear-shaped scars gradually became flat after 1 year of follow-up; fat liquefaction occurred in 1 case 4 days after surgery, re-suturing of the incision was done 1 week after the removal of internal sutures and drainage, and the incision healed well; 1 case developed infection 3 days after surgery, and then received the removal of internal sutures, drainage, and anti-infection treatment, re-suturing was performed after complete regression of the incision swelling, and the incisions healed well; scar hyperplasia occurred in 4 cases 3 to 6 months after surgery, and the scars became flat after the local injection of triamcinolone acetonide. In the remaining children, fine white linear scars were formed after the healing of incisions, the depressions and ridges at both ends of the incisions became flat, and there was no obvious pulling sensation in facial organs or formation of cat′s ear-shaped scars.Conclusions:Subcutaneous asymmetric tension reduction combined with dermal buried angular mattress suture can effectively reduce tension twice during delicate facial surgery in infants and preschoolers, and help to avoid incision widening and scar hyperplasia. The follow-up showed favorable long-term efficacy and aesthetic effect.

Objective To observe the clinical efficacy of self-formulated Shenqi Buwei Decoction(derived from Huangqi Renshen Decoction)in treating patients with stable chronic obstructive pulmonary disease(COPD)differentiated as lung-spleen qi deficiency syndrome.Methods A total of 110 patients with stable COPD differentiated as lung-spleen qi deficiency syndrome were randomly divided into a control group and an observation group,with 55 patients in each group.The control group was given Tiotropium Bromide Inhalation Powder for the inhalation treatment,and the observation group was given Shenqi Buwei Decoction on the basis of treatment for the control group,and the course of treatment covered 3 months.The changes of pulmonary function indicators of forced expiratory volume in one second(FEV1),forced vital capacity(FVC),and one-second rate of FEV1/FVC,modified Medical Research Council index(mMRC)dyspnea scores,6-minute walk test(6MWT),COPD Assessment Test(CAT)scores,and traditional Chinese medicine(TCM)syndrome scores in the two groups were observed before and after treatment.After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1)During the trial,one patient was excluded and two patients fell off from the observation group,and three patients fell off from the control group.Eventually,52 patients in each of the two groups were included in the efficacy statistics.(2)After 3 months of treatment,the total effective rate of the observation group was 80.77%(42/52)and that of the control group was 67.31%(35/52).The intergroup comparison(tested by chi-square test)showed that the therapeutic effect of the observation group was slightly superior to that of the control group,but the difference was not statistically significant(P＞0.05).(3)In terms of indexes,After treatment,the levels of pulmonary function indicators of FEV1,FEV1/FVC in the control group and FEV1,FVC,FEV1/FVC in the observation group were significantly improved compared with those before treatment(P＜0.05),and the improvement of FEV1,FVC,FEV1/FVC in the observation group was significantly superior to that in the control group(P＜0.05).(4)After treatment,the 6MWT,mMRC and CAT scores of the two groups were significantly improved compared with those before treatment(P＜0.05),and the improvement in the observation group was significantly superior to that in the control group(P＜0.05).(5)After treatment,the TCM syndrome scores of the two groups of patients were significantly decreased in comparison with those before treatment(P＜0.05),and the decrease in the observation group was significantly superior to that in the control group(P＜0.05).(6)During the treatment process,no obvious adverse reactions occurred in the two groups of patients,there were no abnormal changes in the safety indicators,either.Conclusion On the basis of conventional western medicine treatment,the combined use of Shenqi Buwei Decoction exerts certain efficacy in the treatment of patients with stable COPD differentiated as lung-spleen qi deficiency syndrome.The combined therapy can effectively improve the ventilation function,relieve the clinical symptoms,improve the quality of life and delay the decline of lung function of the patients.

Objective:To construct a random forest prediction model for non-invasive identification of perineural invasion in gallbladder carcinoma (GBC) based on preoperative enhanced CT imaging features.Methods:The clinical data of 180 patients who underwent curative-intent resection for gallbladder carcinoma at the First Affiliated Hospital of Xi′an Jiaotong University from January 2022 to December 2023 were retrospectively analyzed, including 61 males and 119 females with the age of (65.3±10.2) years old. The 180 patients were divided into a training set ( n=126) and a testing set ( n=54), and based on perineural invasion, the 126 patients in the training set were divided into the perineural invasion group ( n=33) and the non-perineural invasion group ( n=93), and the other 54 patients in the testing set, there were 15 patients with perineural invasion and 39 patients without perineural invasion. Clinical data such as gender, age, perineural invasion, carbohydrate antigen 19-9 (CA19-9) level and tumor stage were collected from patients. Multivariate logistic regression model was used to analyze the risk factors of perineural invasion in gallbladder carcinoma patients. The correlation between clinical variables and perineural invasion was ranked in order of importance using the "feature_importance" package in Python software. Then, we developed a random forest prediction model for perineural invasion in gallbladder carcinoma patients, and the area under the receiver operating characteristic (ROC) curve and confusion matrix were used to assess the predictive ability of the model. Results:Multivariate logistic regression model analysis showed that patients with CA19-9 >39.0 U/ml ( OR=5.165, 95% CI: 1.650-16.174), T3 stage ( OR=6.037, 95% CI: 1.571-23.197), T4 stage ( OR=9.996, 95% CI: 2.177-45.898), and lymph node metastasis ( OR=7.829, 95% CI: 2.705-22.627) were with a high risk of perineural invasion occurrence (all P<0.05). The top three variables in the order of the importance ranking were CA19-9, lymph node metastasis, and T stage. Combining the results of multivariate analysis and importance ranking, CA19-9, lymph node metastasis, and T stage were used to develop a random forest prediction model for perineural invasion in gallbladder carcinoma patients. The results of ROC curve analysis showed that the areas under curves of the random forest model in the training and testing sets were 0.8250 and 0.7667, respectively. The confusion matrix results showed that the sensitivity were 75.76% and 73.33%, the specificity were 80.65% and 76.92%, and the accuracy were 79.36% and 75.93% in the training and testing sets, respectively. Conclusion:Random forest prediction model based on preoperative enhanced CT image features can be used as a noninvasive means of identifying perineural invasion in patients with gallbladder carcinoma.

OBJECTIVE: To investigate the development present situation of the department of critical care medicine in Inner Mongolia Autonomous Region (hereinafter referred to as Inner Mongolia), in order to promote the standardized and homogeneous development of critical care medicine in Inner Mongolia, and also provide a reference for discipline construction and resource allocation. METHODS: A survey study was conducted in comprehensive intensive care unit (ICU) of tertiary and secondary hospitals in Inner Mongolia by online questionnaire survey and telephone data verification. The questionnaire was based on the Guidelines for the Construction and Management of Intensive Care Units (Trial) (hereinafter referred to as the Guidelines) issued by the National Health Commission in 2009 and the development trend of the discipline. The questionnaire covered six aspects, including hospital basic information, ICU basic information, personnel allocation, medical quality management, technical skill and equipment configuration. The questionnaire was distributed in September 2022, and it was filled out by the discipline leaders or department heads of each hospital. RESULTS: As of October 24, 2022, a total of 101 questionnaires had been distributed, 85 questionnaires had been recovered, and the questionnaire recovery rate had reached 84.16%, of which 71 valid questionnaires had been collected in a total of 71 comprehensive ICU. (1) There were noticeable regional differences in the distribution of comprehensive ICU in Inner Mongolia, with a relatively weak distribution in the east and west, and the overall distribution was uneven. The development of critical care medicine in Inner Mongolia was still lacking. (2) Basic information of hospitals: the population and economy restricted the development of ICU. The average number of comprehensive ICU beds in the western region was only half of that in the central region (beds: 39.0 vs. 86.0), and the average number of ICU beds in the eastern region was in the middle (83.6 beds), which was relatively uneven. (3) Basic information of ICU: among the 71 comprehensive ICU surveyed, there were 44 tertiary hospitals and 27 secondary hospitals. The ratio of ICU beds to total beds in tertiary hospitals was significantly lower than that in secondary hospitals [(1.59±0.81)% vs. (2.11±1.07)%, P < 0.05], which were significantly lower than the requirements of the Guidelines of 2%-8%. The utilization rate of ICU in tertiary and secondary hospitals [(63.63±22.40)% and (44.65±20.66)%, P < 0.01] were both lower than the bed utilization rate required by the Guidelines (75% should be appropriate). (4) Staffing of ICU: there were 376 doctors and 1 117 nurses in tertiary hospitals, while secondary hospitals had 122 doctors and 331 nurses. There were significant differences in the composition ratio of the titles of doctors, the degree of doctors, and the titles of nurses between tertiary and secondary hospitals (all P < 0.05). Most of the doctors in tertiary hospitals had intermediate titles (attending physicians accounted for 41.49%), while most of the doctors in secondary hospitals had junior titles (resident physicians accounted for 43.44%). The education level of doctors in tertiary hospitals was generally higher than that in secondary hospitals (doctors: 2.13% vs. 0, masters: 37.24% vs. 8.20%). The proportion of nurses in tertiary hospitals was significantly lower than that in secondary hospitals (17.01% vs. 24.47%). The ratio of ICU doctors/ICU beds [(0.64±0.27)%, (0.59±0.34)%] and ICU nurses/ICU beds [(1.76±0.56)%, (1.51±0.48)%] in tertiary and secondary hospitals all failed to meet the requirements above 0.8 : 1 and 3 : 1 of the Guidelines. (5) Medical quality management of ICU: compared with secondary hospitals, the proportion of one-to-one drug-resistant bacteria care in tertiary hospitals (65.91% vs. 40.74%), multimodal analgesia and sedation (90.91% vs. 66.67%), and personal digital assistant (PDA) barcode scanning (43.18% vs. 14.81%) were significantly higher (all P < 0.05). (6) Technical skills of ICU: in terms of technical skills, the proportion of bronchoscopy, blood purification, jejunal nutrition tube placement and bedside ultrasound projects carried out in tertiary hospitals were higher than those in secondary hospitals (84.09% vs. 48.15%, 88.64% vs. 48.15%, 61.36% vs. 55.56%, 88.64% vs. 70.37%, all P < 0.05). Among them, the placement of jejunal nutrition tube, bedside ultrasound and extracorporeal membrane oxygenation were mainly completed independently in tertiary hospitals, while those in secondary hospitals tended to be completed in cooperation. (7) Equipment configuration of ICU: in terms of basic equipment, the ratio of the total number of ventilators/ICU beds in tertiary and secondary hospitals [0.77% (0.53%, 1.07%), 0.88% (0.63%, 1.38%)], and the ratio of injection pump/ICU beds [1.70% (1.00%, 2.56%), 1.25% (0.75%, 1.88%)] didn't meet the requirements of the Guidelines. The equipment ratio was insuffcient, which means that the basic needs of development had not been met yet. CONCLUSIONS The development of comprehensive ICU in Inner Mongolia has tended to mature, but there is still a certain gap in the development scale, personnel ratio and instruments and equipment compared with the Guidelines. Moreover, the comprehensive ICU appears the characteristics of relatively weak eastern and western regions, and the overall distribution is uneven. Therefore, it is necessary to increase efforts to invest in the construction of the department of critical care medicine.
Humans ; Intensive Care Units ; Critical Care ; Surveys and Questionnaires ; Tertiary Care Centers ; China

OBJECTIVE: To assess the efficacy and safety of Guanxin Danshen Dripping Pills (GXDS) in the treatment of depression or anxiety in patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI). METHODS: From September 2017 to June 2019, 200 CHD patients after PCI with depression and anxiety were included and randomly divided into GXDS (100 cases) and placebo control groups (100 cases) by block randomization and a random number table. Patients in the GXDS and control groups were given GXDS and placebo, respectively, 0.4 g each time, 3 times daily for 12 weeks. The primary outcomes were scores of Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Scale (GAD-7) and the Seattle Angina Pectoris Scale (SAQ). The secondary outcomes included 12 Health Survey Summary Form (SF-12) scores and the first onset time and incidence of major adverse cardiovascular events (MACEs). Other indices including blood pressure, blood lipids, microcirculation and inflammatory-related indices, etc. were monitored at baseline, week 4, and week 12. RESULTS: In the full analysis set (200 cases), after treatment, the PHQ-9 and GAD-7 scores in the GXDS group were considerably lower than those in the control group (P<0.05). Compared with the baseline, the total PHQ-9 scores of the experimental and control groups decreased by 3.97 and 1.18, respectively. The corrected mean difference between the two groups was -2.78 (95% CI: -3.47, -2.10; P<0.001). The total GAD-7 score in the GXDS group decreased by 3.48% compared with the baseline level, while that of the placebo group decreased by 1.13%. The corrected mean difference between the two groups was -2.35 (95% CI: -2.95, -1.76; P<0.001). The degree of improvement in SAQ score, SF-12 score, endothelin and high-sensitive C-reactive protein levels in the GXDS group were substantially superior than those in the placebo group, and the differences between the two groups were statistically significant (P<0.05). Similar results were obtained in the per protocol population analysis of 177 patients. Three cases of MACES were reported in this study (1 in the GXDS group and 2 in the placebo group), and no serious adverse events occurred. CONCLUSIONS GXDS can significantly alleviate depression and anxiety, relieve symptoms of angina, and improve quality of life in patients with CHD after PCI. (Registration No. ChiCTR1800014291).
Humans ; Percutaneous Coronary Intervention/adverse effects* ; Quality of Life ; Depression ; Coronary Disease/drug therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Angina Pectoris/drug therapy* ; Prognosis ; Anxiety ; Treatment Outcome ; Double-Blind Method

Objective:To investigate the risk factors of post-stroke depression (PSD) in patients with first acute stroke 6 months after onset.Methods:Three hundred and sixty-seven patients with acute stroke who were treated for the first time in the Affiliated Hospital of Xuzhou Medical University were selected retrospectively. After onset for 6 months, the patients were followed up and divided into PSD group and non-PSD group. The clinical data, blood index, imaging data, degree of nerve damage and the patient's stigma level were compared between the two groups.Results:Totally 182 and 185 cases were included in the PSD and non-PSD groups, respectively. The incidence of PSD at 6 months post-stroke was 49.6% (182/367). The results of univariate analysis showed that diseased region, drinking history, monthly income, standard of culture, serum cortisol, total cholesterol (TC), high sensitivity C-reactive protein (hs-CRP), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Stigma Scale for Chronic Illness-8 Chronic Disease Stigma Scale-8(SSCI-8) scores, National Institute of Health Stroke Scale (NIHSS) scores and subtype of stroke were risk factors for PSD ( P<0.05). Binary Logistic regression analysis showed that diseased region at frontal lobe ( OR = 3.245, P = 0.011), basal ganglia region ( OR = 2.820, P = 0.007), cerebellar hemisphere ( OR = 4.594, P = 0.010) and serum cortisol ( OR = 1.174, P<0.001), hs-CRP ( OR = 1.057, P<0.001), SSCI-8 scores ( OR = 1.674, P<0.001), NIHSS scores ( OR = 1.283, P<0.001) were independent risk factors for PSD. Conclusions:PSD is a common complication in patients with stroke. Diseased region (at frontal lobe, basal ganglia region, cerebellar hemispheres), hs-CRP, serum cortisol, level of morbidity stigma and degree of neurological impairment are development risk factors for the PSD at 6 months of acute stroke.

AIM:To explore the effect and mechanism of hydrogen sulfide(H2S)on autophagy and angiogene-sis in skin wound of diabetic rats.METHODS:Among 36 healthy 8-week-old male Sprague-Dawley rats,12 rats were se-lected as control group,and the remaining rats were intraperitoneally injected with streptozotocin(STZ)to induce diabetic model and were randomly divided into diabetes mellitus(DM)group and NaHS(H2S donor)intervention(DM+NaHS)group,with 12 rats in each group.A skin trauma model was established by excising the skin of the back of rats in each group.The rats in DM+NaHS group were intraperitoneally injected with NaHS(56 μmol/kg),and the rats in control and DM groups were daily received the same volume of normal saline for 21 consecutive days.The healing of skin wound was measured on days 0,7,14 and 21 after operation.On the 21st day after surgery,the content of H2S in skin tissues was de-tected by C-7Az fluorescent probe,and the morphological changes and angiogenesis of wound tissues were observed by HE staining.The expression of CD31 was detected by immunofluorescence staining,and endothelial autophagy was detected by double staining of CD31 and beclin-1.The protein levels of cystathionine γ-lyase(CSE),CD31,microtubule-associated protein 1 light chain 3(LC3),beclin-1,P62,Bcl-2,Bax,phosphatidylinositol 3-kinase(PI3K),protein kinase B(PKB/Akt)and mammalian target of rapamycin(mTOR)in wound tissues were determined by Western blot.Caspase-3 and propidium iodide(PI)staining was used to detect cell apoptosis,and apoptosis of vascular endothelial cells was deter-mined with CD31 and TUNEL double immunofluorescence staining.RESULTS:Compared with DM group,the wound healing rate,H2S content and CSE protein expression were significantly increased in DM+NaHS group(P＜0.01),but still lower than those in control group(P＜0.01).HE staining showed that the wound surface in DM group was thin and wide,with few capillary,while that in DM+NaHS group was thicker with lots of capillary and wound width was reduced.Com-pared with DM group,CD31 expression was markedly increased(P＜0.01),the fluorescence intensity of caspase-3 and PI was significantly decreased(P＜0.01),and CD31+/beclin-1+ as well as CD31+/TUNEL+ cells were decreased(P＜0.01)in DM+NaHS group.Western blot analysis showed that compared with DM group,the levels of beclin-1,Bax and LC3-Ⅱ/LC3-Ⅰ were significantly decreased(P＜0.01),while the levels of P62 and Bcl-2,as well as ratios of p-PI3K/PI3K,p-Akt/Akt and p-mTOR/mTOR were significantly increased(P＜0.01)in DM+NaHS group.CONCLUSION:H2S can promote skin wound healing,which may be related to activation of PI3K/Akt/mTOR signaling pathway,inhibition of endothelial au-tophagy and apoptosis,and promotion of angiogenesis in diabetic rats.

Child ; Humans ; Inflammatory Bowel Diseases ; Organic Anion Transporters/genetics*

ObjectiveThis study aimed to assess the circulating bilirubin profile ［total bilirubin （TBIL）， conjugated bilirubin （DBIL）， unconjugated bilirubin （IBIL）］ and their associations with nonproliferative diabetic retinopathy （NPDR）. MethodsA case-control study which enrolled 312 type 2 diabetic mellitus （T2DM） patients （78 newly diagnosed NPDR 1：3 matched with 234 T2DM without diabetic retinopathy） was conducted. Diabetic retinopathy was screened by artificial intelligence fundus camera and further confirmed by the ophthalmologist， and demographic and clinical information were collected. Serum bilirubin and related biochemical indicators were assessed. ResultsPatients with NPDR had significantly lower serum TBIL， DBIL and IBIL concentrations （P values were 0.003， 0.001 and 0.006）， which were not associated with glycated hemoglobin （HbA1c） concentration （all P values >0.05）. The association persisted after adjustment for traditional risk factors including gender， diabetes duration， HbA1c and systolic blood pressure. Moreover， low IBIL had a higher risk of NPDR with odds ratio （OR） 95%CI of 3.44 （1.04， 11.38） in well glycemic controlled T2DM patients （HbA1c ≤7%） or of 2.53 （1.10， 5.82） in T2DM patients without microalbuminuria ［urine albumin creatine ratio （UACR） ≤30mg/g］； low DBIL had a higher risk of NPDR with OR 95%CI of 2.05 （1.09， 3.86） in poor glycemic controlled T2DM patients （HbA1c>7%） or of 2.40 （1.14， 5.02） in T2DM patients with microalbuminuria （UACR >30mg/g）. ConclusionOur results suggested that circulating bilirubin level is inversely and independently associated with NPDR which might be an early clinical biomarker for predicting and preventing diabetic retinopathy.