Hepatolenticular degeneration， also known as Wilson disease （WD）， is a hereditary disease caused by mutations in the ATP7B gene， leading to copper metabolism disorders. Gene mutations result in impaired synthesis of copper-binding protein， and abnormal excretion of copper through bile leads to pathological deposition of copper in various organs， ultimately causing multi-organ damage. The insidious onset and low specificity of symptoms make it difficult to diagnose this disease. On the basis of existing studies and the theory of latent toxin， this paper proposes that latent toxin in kidney collaterals is the main pathogenesis of renal injury in WD. It is pointed out that health Qi deficiency and latent pathogen are the premises for the occurrence of this disease， and the transformation of latent pathogen into toxin is the ley pathological process. Toxin damaging kidney collaterals is the ultimate result. According to the pathogenesis， this paper proposes the treatment principle of reinforcing healthy Qi and resolving toxin and treatment based on syndrome differentiation. This review provides new ideas for the diagnosis and treatment of renal injury in WD with traditional Chinese medicine.

ObjectiveTo observe the clinical efficacy of Gandouling decoction combined with neuromuscular electrical stimulation （NMES） in the treatment of dysphagia in Wilson disease （WD） with combined phlegm and stasis. MethodsA total of 80 WD patients with dysphagia due to combined phlegm and stasis treated in the Department of Encephalopathy， the First Affiliated Hospital of Anhui University of Chinese Medicine were randomized into a control group and an observation group， with 40 patients in each group. In addition， 40 healthy volunteers were recruited as the normal group. The control group was treated with basic copper drainage combined with NMES. The observation group was treated with Gandouling Decoction on the basis of the therapy in the control group. Each course of treatment lasted for 8 days， and the patients were treated for a total of 4 courses. All subjects underwent video fluoroscopic swallowing study （VFSS） before and after treatment. During the examination， contrast agents with 4 different characters were used for the swallowing action， and the passing time was recorded. The TCM syndrome score， water swallow test score， standard swallowing assessment （SSA） score， and 24-h urinary copper level before and after treatment were analyzed. ResultsWhen performing VFSS， the passing time of contrast agents of different characters in the oral stage was longer in the WD group than in the normal group （P<0.01）， while it had no significant difference in the pharyngeal stage. After treatment， the passing time in the oral stage shortened in the control and observation groups （P<0.01）， and the observation group outperformed the control group （P<0.01）. After treatment， both the control and observation groups showed declines in TCM syndrome score and SSA score （P<0.01） and an increase in water swallow test score （P<0.01）， and the changes were more obvious in the observation group than in the control group （P<0.01）. In addition， the treatment in the control and observation groups elevated the 24-h urinary copper level （P<0.01）， and the elevation in the observation group was more obvious than that in the control group （P<0.01）. Neither group showed obvious adverse reaction. ConclusionGandouling decoction combined with NMES can significantly ameliorate dysphagia in WD patients with the syndrome of combined phlegm and stasis regarding the TCM syndrome score， water swallow test score， and SSA score， demonstrating definite clinical efficacy and high safety.

Objective To investigate the relationship between the expression of discoidin,CUB and LCCL domain containing protein 1(DCBLD1)and cytoskeleton associated protein 2(CKAP2)in cervical cancer(CC)tissues and epithelial mesenchymal transition(EMT)and clinical prognosis.Methods 94 CC patients diagnosed and treated in Shiyan Hospital of Traditional Chinese Medicine from February 2017 to February 2019 were selected.The expression of DCBLD1 messenger ribonucleic acid(mRNA),CKAP2 mRNA,N-cadherin(N-cad)mRNA,vimentin(Vim)mRNA and TWIST mRNA in tissues was detected by real-time fluorescence quantitative PCR(qRT-PCR).The expressions of DCBLD1 and CKAP2 were detected by immunohistochemistry(IHC).Pearson correlation analysis was used to analyze the relationship between DCBLD1 mRNA,CKAP2 mRNA and EMT-related indicators.Kaplan-Meier survival curve was drawn to compare the prognosis of CC patients with different DCBLD1 mRNA and CKAP2 mRNA expression.COX regression analysis was used to analyze the prognostic factors of CC patients.Results The expression of DCBLD1 mRNA,CKAP2 mRNA,N-cad mRNA,Vim mRNA and TWIST mRNA in CC cancer tissues was higher than that in adjacent tissues,and the differences were statistically significant(t=32.763～52.824,all P<0.05).The positive rates of DCBLD1 protein(89.36%)and CKAP2 protein(87.23%)in CC cancer tissues were higher than those in adjacent normal tissues(7.45%,6.38%),and the differences were statistically significant(χ2=126.278,123.396,all P<0.001).The expression of DCBLD1 mRNA and CKAP2 mRNA in CC cancer tissues were positively correlated with the expression of N-cad mRNA,Vim mRNA and TWIST mRNA(r=0.655～0.744,all P<0.001).The expression of DCBLD1 mRNA and CKAP2 mRNA in patients with FIGO stage IB2～IIB and lymph node metastasis were higher than those in patients with stage IA～IB1 and without lymph node metastasis(t=25.644～35.674,all P<0.05).The 5-year progression free survival rates of the high expression groups of DCBLD1 mRNA and CKAP2 mRNA were 63.04%and 62.22%,respectively,which were lower than those of the low expression groups of DCBLD1 mRNA and CKAP2 mRNA(91.67%and 91.84%),respectively,and the differences were statistically significant(Log-Rank χ2=7.181,6.527,all P<0.05).FIGO stage IB2～IIB,high DCBLD1 mRNA and high CKAP2 mRNA were risk factors affecting the prognosis of CC patients(Wald χ2=8.277,15.877,10.927,all P<0.05).Conclusion The expression of DCBLD1 and CKAP2 in CC cancer tissues is significantly increased,which is related to EMT related indicators and plays a promoting role in the progression of CC tumors.They are new prognostic markers for CC.

Objective To investigate the relationship between the expression of discoidin,CUB and LCCL domain containing protein 1(DCBLD1)and cytoskeleton associated protein 2(CKAP2)in cervical cancer(CC)tissues and epithelial mesenchymal transition(EMT)and clinical prognosis.Methods 94 CC patients diagnosed and treated in Shiyan Hospital of Traditional Chinese Medicine from February 2017 to February 2019 were selected.The expression of DCBLD1 messenger ribonucleic acid(mRNA),CKAP2 mRNA,N-cadherin(N-cad)mRNA,vimentin(Vim)mRNA and TWIST mRNA in tissues was detected by real-time fluorescence quantitative PCR(qRT-PCR).The expressions of DCBLD1 and CKAP2 were detected by immunohistochemistry(IHC).Pearson correlation analysis was used to analyze the relationship between DCBLD1 mRNA,CKAP2 mRNA and EMT-related indicators.Kaplan-Meier survival curve was drawn to compare the prognosis of CC patients with different DCBLD1 mRNA and CKAP2 mRNA expression.COX regression analysis was used to analyze the prognostic factors of CC patients.Results The expression of DCBLD1 mRNA,CKAP2 mRNA,N-cad mRNA,Vim mRNA and TWIST mRNA in CC cancer tissues was higher than that in adjacent tissues,and the differences were statistically significant(t=32.763～52.824,all P<0.05).The positive rates of DCBLD1 protein(89.36%)and CKAP2 protein(87.23%)in CC cancer tissues were higher than those in adjacent normal tissues(7.45%,6.38%),and the differences were statistically significant(χ2=126.278,123.396,all P<0.001).The expression of DCBLD1 mRNA and CKAP2 mRNA in CC cancer tissues were positively correlated with the expression of N-cad mRNA,Vim mRNA and TWIST mRNA(r=0.655～0.744,all P<0.001).The expression of DCBLD1 mRNA and CKAP2 mRNA in patients with FIGO stage IB2～IIB and lymph node metastasis were higher than those in patients with stage IA～IB1 and without lymph node metastasis(t=25.644～35.674,all P<0.05).The 5-year progression free survival rates of the high expression groups of DCBLD1 mRNA and CKAP2 mRNA were 63.04%and 62.22%,respectively,which were lower than those of the low expression groups of DCBLD1 mRNA and CKAP2 mRNA(91.67%and 91.84%),respectively,and the differences were statistically significant(Log-Rank χ2=7.181,6.527,all P<0.05).FIGO stage IB2～IIB,high DCBLD1 mRNA and high CKAP2 mRNA were risk factors affecting the prognosis of CC patients(Wald χ2=8.277,15.877,10.927,all P<0.05).Conclusion The expression of DCBLD1 and CKAP2 in CC cancer tissues is significantly increased,which is related to EMT related indicators and plays a promoting role in the progression of CC tumors.They are new prognostic markers for CC.

ObjectiveTo establish and evaluate a mouse model of heart failure with Qi deficiency syndrome. MethodForty-four KM mice were randomly divided into sham operation group， model group， and modified Si Junzitang group （12.89 g·kg^-1）. The model group and the modified Si Junzitang group underwent thoracic aortic constriction （TAC）， while the sham operation group only underwent suture without constriction. Echocardiography and pathological examination were used to assess the heart failure model and evaluate the pharmacological effects. Macroscopic characterization， microscopic biology， and formula identification were conducted to collect general signs， body weight， open-field behavior， grip strength， mitochondrial ultrastructure， and other macroscopic and microscopic characteristics of mice. Mitochondrial fission and fusion protein expression were measured to determine the syndrome type. ResultEight weeks after TAC， compared with the sham operation group， the model group showed a significant decrease in left ventricular ejection fraction （LVEF） （P<0.01）， and modified Si Junzitang improved LVEF in mice （P<0.05）. Hematoxylin-eosin （HE） staining of the heart showed inflammatory cell infiltration and thickening of blood vessel walls in the model group， which was significantly improved by modified Si Junzitang. After 6-8 weeks， compared with the sham operation group and the modified Si Junzitang group， the model group exhibited significant hair loss， hair yellowing， decreased activity， and depression. Moreover， compared with the sham operation group， the model group had a significantly lower increase in body weight （P<0.05）， while the modified Si Junzitang group showed a significant increase in body weight （P<0.05） compared with the model group. After 6-8 weeks， compared with the sham operation group， the model group showed a significant decrease in open-field distance and speed （P<0.05）， while the modified Si Junzitang group exhibited significantly improved open-field distance and speed in the 8^th week （P<0.05）. After 6-8 weeks， compared with the sham operation group， the model group exhibited a significant decrease in maximum grip strength （P<0.05）， while the modified Si Junzitang group showed a significant increase in maximum grip strength 8 weeks after TAC （P<0.05）. Transmission electron microscopy of the gastrocnemius muscle showed uneven muscle tissue matrix， mitochondrial swelling， increased volume， matrix dissolution， ridge loss， and vacuolization in the model group， while modified Si Junzitang improved mitochondrial swelling， ridge fracture， and matrix vacuolization. Western blot analysis showed that the expression of the kinetic associated protein 1 （DRP1） in the gastrocnemius muscle of the model group significantly increased （P<0.01）， and the expression of mitochondrial fusion hormone 1 （MFN1） significantly decreased （P<0.05） as compared with those in the sham operation group. Furthermore， compared with the model group， the modified Si Junzitang group exhibited a significant decrease in the expression of DRP1 （P<0.05） and a significant increase in MFN1 expression （P<0.01）. ConclusionMice exhibited significant manifestations of qi deficiency syndrome 6-8 weeks after TAC， accompanied by abnormal mitochondrial morphology and function in the gastrocnemius muscle， which were significantly improved by modified Si Junzitang.

Objective Toinvestigatethechangesofcognitiveimpairmentandcerebralhemodynamics inpatientswithacutelacunarcerebralinfarctionwithin2weeksafteronset.Methods Nineteenpatients with lacunar cerebral infarction (a patient group)were consecutive enrolled in the study. Twenty-three sex-and age-matched inpatients without ischemic cerebrovascular disease or healthy volunteers of outpatient department over the same period were used as a control group. The cerebral hemodynamic features were evaluated with transcranial Doppler (TCD)breath-holding test and single photon emission computed tomography (SPECT)resting + adenosine stress imaging. Simultaneously,the neuropsychological tests were performed,the Montreal cognitive assessment (MoCA)was performed including executive capacity, structural capacity,memory (including auditory memory,visual memory,and logic memory ),information processing speed,and visual-spatial ability. Results (1 )There were no significant differences in the years of education,hypertension,diabetes,hyperlipidemia,coronary heart disease,and smoking between the 2 groups (all P>0. 05). Compared with the control group,there were significant differences in the MoCA score,visual memory,executive function,structural capacity,and information processing speed of the patient group (all P<0. 05). (2)19 patients completed the SPECT resting + load test (12 in the control group and 7 in the patient group). There were significant differences in the uptake ratio (UR)in the right basal ganglia (8. 91[-2. 48 - 5. 87]and -6. 21 [-10. 39 - 5. 42 respectively])and left frontal lobe UR (11. 62 [2. 93-16. 87]and 1. 04 [-10. 17- 3. 82]respectively)between the patient group and the control group (P<0. 05). (3)26 patients completed the breath-holding test + head-up tilt table test (n=13 in each group]. The vascular motor reactivities were 13 ± 5 on the left and 21 ± 7 on the right, and the breath-holding indexes were 0. 66 ± 0. 26 on the left and 1. 0 ± 0. 4 on the right in the patient group;the vascular motor reactivities were 24 ± 11 on the left and 30 ± 9 on the right,and the breath-holding indexes were 1. 21 ± 0. 57 on the left and 1. 5 ± 0. 4 on the right in the control group. There were significant differencesbetweenthe2groups(P<0.05).Conclusion Attheearlystageoflacunarinfarction,the patients have presented varying degrees of cognitive impairment and the changes of cerebral hemodynamics.

Objective To observe the expression of neuron specific enolase (NEC) to evaluate the neuroprotective effect of a cell-penetrating Bax-inhibiting peptide (BIP) on neonatal rats with hypoxic-ischemic brain damage (HIBD). Methods Wi-star rats (7-day old) were randomly divided into Sham group, BIP group and HIBD group. After modeling HIBD, the histologi-cal (HE staining) and immunohistochemistry methods were used to determine the apoptotic pathological changes and the NSE expression levels in the brain at different time points. Results Compared to the Sham group, the rats of HIBD group showed significant apoptotic pathological changes. The histological changes and the brain damages were improved significantly in BIP group at each sampling point. The number of NSE-positive cells was significantly decreased in HIBD and BIP groups over time (P<0.05). The number of NSE-positive cells had significant difference among different groups at 48 h, 96 h and 7 d after opera-tion (F=45.35-81.66, P<0.01). The number of NSE-positive cells in the HIBD group was smaller than that of the Sham group and BIP group 48 h after operation (P<0.05). The number of NSE-positive cells in the BIP group was smaller than that of the Sham group 96 h after operation (P<0. 05). Conclusions BIP can decrease the apoptosis of cortex nerve cells in 7-day old HIBD rat model, and may have neuroprotective effect on the early stage of HIBD.

Objective To investigate whether problem-based learning (PBL) is suitable for medical imaging and whether PBL is more enlightening than lecture-based learning (LBL) mode in teaching of medical imaging.Methods Thirty-two students of clinical medicine specialty in Sun Yat-sen University were selected as teaching objects and were divided into 6 groups (5 students in four groups and 6students in 2 groups).Chapters of urinary and digestive system were taught by PBL mode while the rest chapters by LBL mode.Questionnaires were handed out to teachers and students by Email after class and the valid questionnaires were analyzed qualitatively.Results Thirty-one students and 5 teachers thought they were suitable for PBL teaching; 30 students and 5 teachers were willing to continue PBL.Thirty-one students and 5 teachers thought that PBL mode could let students learn more knowledge and was more revealing.Twenty-three students thought PBL teaching spent too much time can not promote in all chapters.Three teachers worried that PBL mode would cause poor organization form and teaching plans.Conclusions PBL is suitable for medical imaging teaching.PBL could let students learn more knowledge and is more revealing compared with LBL,however,PBL is time-consuming and laborious,therefore LBL and PBL should be combined.

Objective To investigate the risk factors of incidence of hypertensive disorder complicating pregnancy(HDCP)and provide reference for prevention and treatment of HDCP.Methods The clinical information of 2 217 cases of maternal delivery were retrospectively analyzed;The relevant social factors and obstetric factors of HDCP were analyzed.Results 186 cases of HDCP occurred in 2 217 cases of maternal,the incidence rate of HDCP was 8.4%.The single-factor analysis showed that the place of residence.prenatal system checks and parity had certain degree of contact with incidence of HDCP(χ2=11.2331,10.6781,5.4456,all P＜0.05),and the age,abortion history and parity had no significant correlation with incidence of HDCP(χ2=4.9201,3.0134,1.7301,all P＞0.05).Multivariate Logistic regression analysis showed that the rural living and no prenatal system check were risk factors of incidence of HDCP.Conclusion The maternal of rural living and no prenatal system check were the high-risk population of HDCP,and emphasis assessment and reasonable control these factors could reduce the incidence of HDCP.

Objective To investigate the effect of hysterectomy and uterine arterial embolization on the function of ovary.Methods The serum concentrations of estrin(E2), progestogen(P),fouicule-stimulating hormone(FSH),luteotropic hormone(LH) and prolaction(PRL) were measured in 18 patients undergone hysterectomy (group Ⅰ),15 patients undergone uterine arterial emboliation(group Ⅱ) and 30normal women (group Ⅲ or control group).These five hormones were compared in each group.Results The serum concentrations of E2 and P in the group Ⅰ were lower than that in group Ⅲ, there was significant difference between them.The serum concentrations of E2 and P in group Ⅱ and group Ⅲ was no significant difference.Conclusion Hysterectomy has significant effects on the function of ovary,while uterine arterial embolization has not.