Objective To optimize the water extraction process of modified Wendan Formula.Methods The comprehensive scores of the content of naringin and neohesperidin as well as the extraction yields of solids were used as the evaluation indexes,the number of decoctions,the decoction time and the solid-liquid ratio as three factors were take into consideration,L9(34)orthogonal experiment was designed to optimize the water extraction process of modified Wendan Formula.Results Combining the orthogonal experiment with the principle of energy conservation and emission reduction in actual production,this study suggests that the optimized process was under the conditions of 1∶8 for the solid-liquid ratio,decoction were performed twice,the first time was 1.5 hours,and the second time was 1 hour.The average composite score of validation of three batches of modified Wendan Formula was 99.00％.Conclusion Such optimized process was stable,feasible and realizable,and it can be applied in water extraction process of modified Wendan Formula.

Objective A HPLC-quantitative analysis of multi-components by single marker(QAMS)was established to determine 5 ingredients including uracil,uridine,hypoxanthine,inosine and guanosine in Periplaneta americana.Methods Separation took place on a Agilent ZORBAX SB-Aq column(250 mm×4.6 mm,5 μm)by gradient elution of methanol-0.01 mol·L-1 potassium dihydrogen phosphate at 20℃with a flow rate of 1.0 mL·min-1.The detection wavelength was 260 nm and the injection amount was 10 μL.The relative correction factors(fa/b)was calculated for the other four components with uridine as an internal standard.The content of 5 ingredients in 10 batches of Periplaneta americana was determined by QAMS.Results were compared with those of external standard method(ESM).Results Five nucleosides showed good linear relationships in their own ranges(r＞0.999 5),and the average recoveries ranged from 97.0%to 100.8%.The relative correction factors of uracil,hypoxanthine,inosine and guanosine were 0.908 0,1.005 3,1.969 5 and 1.303 4,respectively.Conclusion The established method is accurate and stable.It can provide theoretical reference for the quality control of Periplaneta americana.

Objective To conduct a network meta-analysis on the effectiveness of first-line immunotherapy on patients with brain metastases from advanced non-small cell lung cancer(NSCLC).Methods Two investigators conducted a computerized search of Pubmed,Embase,Cochrane,and other databases to screen the literature,extract the information,and assess the risk of bias of the included studies.The included clinical trials were statistically analyzed using R(4.1.3)software.For the study outcome indicators OS and PFS,the risk ratios(HRs),and the 95%confidence intervals(CIs)were extracted from the included studies and logarithmically transformed into effect analysis statistics.Results Six randomized controlled trials were finally included,including 327 patients with non-excludable NSCLC brain metastases.Network meta-analysis suggested that PD-1 inhibitor+CTLA-4 was more advantageous than the conventional chemotherapy for enhancing patients'OS(HR:0.13,95%CI:0.03-0.71),followed by PD-L1 inhibitor(HR:0.17,95%CI:0.04-0.74)and PD-1 inhibitor+chemotherapy(HR:0.36,95%CI:0.2-0.63).PD-1 inhibitor+CTLA-4 was also more advantageous(HR:0.37,95%CI:0.15-0.93)than the conventional chemotherapy for boosting patients'PFS,followed by PD-L1 inhibitor+chemotherapy(HR:0.44,95%CI:0.29-0.66)and PD-1 inhibitor(HR:0.48,95%CI:0.27-0.86).Conclusion Immune checkpoint inhibitor therapy improves the survival of patients with brain metastases from advanced NSCLC.In particular,the combination of PD-1 inhibitor and CTLA-4 inhibitor show excellent survival benefit.

Objective:To elucidate the pathophysiological mechanisms of idiopathic inflammatory myopathy subtypes by analyzing the gene expression profiles of peripheral blood mononuclear cells (PBMCs) from anti-MDA5 antibody-positive and anti-Jo-1 antibody-positive myositis patients.Methods:Gene expression profiling screening and analysis of PBMCs from 12 anti-MDA5 positive, 16 anti-Jo-1 positive myositis patients and 43 healthy controls were performed using Illumina HT-12 v4 expression profiling microarrays. Applying the unpaired t test with Benjamini-Hochberg correction, the genes with the absolute value of fold change (FC) in gene expression signal ≥2 and adjusted P<0.05 were selected as differentially expressed genes. Differential gene sets were subjected to Gene Ontology (GO) functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, with P<0.05 as the threshold for being significantly enriched. Validation of differentially expressed genes by real time-PCR. The Kolmogorov-Smirnov test was used to test the normality of continuous variables. If the distribution was normal and the variance was homogeneous, analysis of variance (one-way ANOVA) was used.If the distribution was not normal, Kruskal-Wallis test was used, and P<0.05 was regarded as statistically significant difference. Results:Analysis of gene expression profiles of PBMCs from patients with positive anti-MDA5 and anti-Jo-1 antibody revealed significant differences in gene expression of PBMCs from patients with the two myositis subtypes. The number of differentially expressed genes that specifically up-regulated in anti-MDA5 antibody positive patients was 407, and the GO functional enrichment analysis was mainly enriched in biological processes such as innate immune response ( P<0.001), response to virus ( P<0.001) and type Ⅰ interferon signaling pathway ( P<0.001), and the KEGG pathway enrichment analysis was mainly enriched in the viral infection-associated pathway ( P<0.001), RIG-Ⅰ like receptor signaling pathway ( P<0.001) and Toll-like receptor signaling pathway ( P=0.002), etc. The 259 differential genes specifically down-regulated in the anti-MDA5 antibody positive group were mainly enriched in biological processes such as immune response ( P=0.006), TGF-β receptor signaling pathway ( P=0.010) and natural killer cell mediated immunity ( P=0.015) in GO functional enrichment analysis. There were 162 differentially expressed genes up-regulated specifically in anti-Jo-1 antibody positive patients, and GO functional enrichment analysis was mainly enriched in biological processes such as nucleosome assembly ( P<0.001), negative regulation of cell growth ( P=0.001), negative regulation of apoptotic process P=0.004), and innate immune response in mucosa ( P=0.012), and the KEGG pathway enrichment analysis mainly enriched in metabolic-related signaling pathways ( P<0.001) and immune-related pathways ( P<0.001), etc. Real-time PCR confirmed that IFIH1 ( P=0.037), ISG15 ( P=0.003), and DDX58 ( P=0.032) in the RIG-Ⅰ-like receptor pathway as well as chemokines MCP-1 ( P=0.003), MCP-2 ( P<0.001), and transcription factor BATF2 ( P=0.002), and inflammatory signaling pathway-associated MYD88 ( P<0.001) were highly expressed in PBMCs from anti-MDA5 antibody-positive myositis patients. Conclusion:The gene expression profile of PBMCs in anti-MDA5 antibody-positive patients suggests that the pathogenesis of patients with anti-MDA 5 antibody positive is closely related to biological processes such as innate immune response, viral infection, and interferon response.

Objective To observe the changes in the symptoms and relevant physiological indicators in subjects after inhaling the hypoxic air produced by a hypoxic air generator at a low altitude prior to their entry into high-altitude environment,and to explore its early warning effect for acute mountain sickness(AMS)among the subjects upon their subsequent entry into high-altitude environment.Methods A total of 50 subjects who were going to visit high-altitude regions were enrolled.All subjects were men,with an average age of(22.00±1.52)years.They continuously inhaled for 30 minutes hypoxic air(which simulated the air at the altitude of 5200 m,with an oxygen content 10.80％)generated by a hypoxic air generator.During this period fingertip oxygen saturation,heart rate,blood pressure,and symptoms of discomfort were observed and recorded.On the fourth day after living at an altitude of 4020 m,the subjects completed the evaluation for the symptom scores of acute mild altitude disease(AMAD).The subjects were divided into a maladjusted group(18 cases)and a well-adjusted group(32 cases)according to whether they experienced discomfort(including drowsiness,dizziness,chest tightness,cold sweating of the hands,etc.)during the inhalation of hypoxic air at a low altitude.After entry into the high-altitude environment,they were divided into an AMS group(28 cases)and a non-AMS group(22 cases)according to whether they experienced AMS after entering the he high-altitude environment.The primary indicator was the incidence of AMS,including the incidence of AMAD and severe acute mountain sickness(SAMS),and the incidence of AMS in the maladjusted group and the well-adjusted group after entering high-altitude environment.The secondary indicator was the relationship between the changes in fingertip oxygen saturation after inhaling hypoxic air at a low altitude and the incidence of AMS and the AMAD symptom scores.Results All 50 subjects traveled by air to the target altitude of 4020 m above sea level at the same time.The AMS incidence among them was 56.0％(28/50),with the incidence of AMAD being 54.0％(27/50)and the incidence of SAMS being 2.0％(1/50).In the single case of SAMS,the patient had high-altitude pulmonary edema.The incidences of AMS after entering high-altitude environment in the maladjusted and well-adjusted groups were 88.9％(16/18)and 37.5％(12/32),respectively,and the difference was statistically significant(P＜0.01).In the 50 subjects,fingertip oxygen saturation decreased rapidly in the first 11 minutes into the inhalation of hypoxic air at a low altitude,with a more pronounced decrease in the AMS group than that in the non-AMS group,and the differences between the groups were statistically significant after 5,9,and 11 minutes(P＜0.05).Fingertip oxygen saturation plateaued in the 50 subjects from the 12th to the 30th minute,with no significant differences between the AMS and non-AMS groups.The mean value of fingertip oxygen saturation within 30 minutes of hypoxic air inhalation was negatively correlated with the AMAD symptom scores after subjects'entry into high-altitude environment(r=-0.300).Conclusion Those who experience symptoms of discomfort after exposure to hypoxic air produced by a hypoxic air generator at a low altitude are more likely to develop AMS and close attention should be paid to the decrease in fingertip oxygen saturation within the first 11 minutes.

The tumors of central nervous system refer to a group of benign and malignant diseases originating from tissues or structures within the central nervous system. Common tumors of central nervous system are sporadic, but a few have familial onset. Compared with sporadic brain tumors, the clinical symptoms, diagnostic ideas and follow-up review plans of familial brain tumors are more complicated. The multidisciplinary diagnosis and treatment (MDT) mode usually refers to a treatment mode in which a case involving multiple organs and systems is discussed, and the best treatment plan is formulated for the patient based on the comprehensive opinions of various disciplines. Because familial brain tumors often involve multiple organs, multiple disciplines and multiple systems, and their low incidence leads to less clinical experience for neurosurgeons, the MDT model is more conducive to efficient diagnosis, treatment and management of familial brain tumors. This review elaborates on the neurosurgeon-led MDT model, and introduces the latest research on the epidemiology, genetic characteristics, clinical manifestations, diagnostic ideas and multidisciplinary management of familial brain tumors.

OBJECTIVE: To systematically evaluate therapeutic efficacy and safety of Compound kushen colon-release capsule versus related chemical drugs in treatment of ulcerative colitis (UC).METHODS: Retrieved from PubMed, Embase, Cochrane library, China Journal Full-text Database (CJFD), VIP, CBM and Wanfang database, RCTs about therapeutic efficacy (response rate, TCM syndrome, therapeutic efficacy of mucosal lesion) and safety (the incidence of ADR) of Compound kushen enteric-release capsule versus related chemical drugs in the treatment of UC were collected. Meta-analysis was conducted by using Rev Man 5. 3 statistical software after data extraction and quality evaluation with Cochrane 5. 1. 0. RESULTS: A total of 9 RCTs were included, involving 649 patients. The results of Meta-analysis showed that response rate [OR=2. 16, 95％CI(1. 28, 3. 63), P=0. 004] and therapeutic efficacy of mucosal lesion [OR=2. 42, 95％ CI(1. 07, 5. 47), P=0. 03] of Compound kushen colon-release capsule were significantly higher than that of chemical drugs in the treatment of UC, with statistical significance. There was no statistical significance in therapeutic efficacy of TCM syndrome [OR=1. 70, 95％CI(0. 87, 3. 32), P=0. 12] or the incidence of ADR between 2 groups. CONCLUSIONS: Therapeutic efficacy of Compound kushen colon-release capsule is better than that of related chemical drugs in the treatment of UC with similar safety.

OBJECTIVE:To systematically evaluate the clinical efficacy and safety of Compound Huangbo liquid combined with chemical medicine in the treatment of ulcerative colitis (UC),and to provide evidence-based reference.METHODS:Re trieved from CBM,Wanfang Database,VIP,CJFD,PubMed,EMBase and Cochrane Library,randomized controlled trials(RCTs) about Compound Huangbo liquid combined with chemical medicine (trial group) vs.chemical medicine alone (control group) in the treatment of UC were collected.Meta-analysis was performed by using Rev Man 5.3 statistical sofetware after literature scanning,data extraction and quality evaluation according to Cochrane reviewer's handbook 5.1.0.RESULTS:A total of 8 RCTs were included,involving 737 patients.The results of Meta-analysis showed that,response rate of trial group was significantly higher than that of control group,with statistical significance [OR=4.69,95 ％ CI(3.00,7.34),P＜0.001];there was no statistical significance in the incidence of ADR between 2 groups [OR=0.94,95 ％ CI (0.48,1.84),P=0.86].CONCLUSIONS:Compound Huangbo liquid combined with chemical medicine is better than chemical medicine alone for UC,and both have similar safety.

Objective To investigate the characteristics of the bone marrow mesenchymal stem cell(MSC)in children with aplastic anemia(AA)in vitro,and the expressions of tumor necrosis factor -α-induced protein -8 -like 2(TIPE2)in the bone marrow,and the correlation between the level of TIPE2 mRNA with γ-interferon(IFN -γ)and IL -6 in AA patients.Methods Bone marrow samples were collected from 1 8 children with AA(AA group)and 8 children with bone injury (control group)who were hospitalized in Jinan Children′s Hospital from January 201 2 to June 201 5.MSC were isolated and cultured.The morphology of MSC was observed and immune phenotype was detected.The TIPE2 mRNA was detected by using real -time fluorescence quantitative PCR,and the levels of IFN -γand IL -6 were detected by using enzyme linked immunosorbent assay.Results Different sizes had been presented in the primi-tive MSC of AA patients,but the third passage MSC until 80% confluence had manifested the uniform convergence with long spindle and swirl distribution.In the sixth passage,cells showed degenerative change.The primitive and first pa-ssage MSC in patients with AA was longer than that in the controls.CD73 ,CD1 05 ,CD44 and CD90 were expressed in MSC,while CD34 ,CD45 ,CD271 expressed rarely.The level of TIPE2 mRNA in AA patients (5.29 ±1 .56)was obviously lower than that of the control group(8.68 ±2.00),and the difference was significant(t =-4.48,P <0.01 ).The con-centration of IFN -γ[(5.48 ±1 .97)ng/L]and IL -6[(5.43 ±1 .92)ng/L]in AA patients were higher than those of the control group[(3.40 ±1 .24)ng/L,(3.79 ±0.92)ng/L],and the differences were significant (t =2.70, 2.26,all P <0.05).The level of TIPE2 mRNA in AA patients was negatively related with IFN -γand IL -6(r =-0.838,-0.658,all P <0.05),but there was no significant correlation between them in the control group (all P >0.05).Conclusions The proliferation of MSC is significantly reduced in patients with AA.TIPE2,as an important role to stabilize the immune system,plays an important role in the occurrence of AA by its low expression and up -regula-ting the expression of inflammatory factors.