Objective:To evaluate the effect of Yiyiren Decoction on the prevention and treatment of collagen induced arthritis with syndrome of cold-dampness obstruction (CIA-CDO) its mechanism.Methods:A cold dampness obstruction type CIA rat model was prepared by injecting type Ⅱ collagen and simulating a cold and humid environment in an artificial climate chamber. The successfully modeled rats were randomly divided into a model group, a positive group, and Yiyiren Decoction high- and low-dosage groups according to a random number table method. Additionally, 8 normal rats were set as the blank group. The Yiyiren Decoction high- and low-dosage groups were orally administered with Yiyiren Decoction at dosages of 24 and 12 g/kg, the positive group was orally administered with leflunomide at a dosage of 10 mg/kg, and the blank group and model group were orally administered with equal volumes of normal saline once a day for 4 consecutive weeks. The overall signs of the rats were observed daily, and the arthritis index (AI) of the limbs and paws was assessed weekly; after 4 weeks of drug administration, the serum levels of pro-inflammatory cytokines (TNF-α and IL-1β) and anti-inflammatory cytokines (IL-4 and IL-10) were detected by ELISA, histopathology of the ankle joint sections was observed under the light microscope, and gene expressions of synovial MMP-3 and TIMP-1 were determined by RT-qPCR.Results:The overall physical signs and joint symptoms of rats in the Yiyiren Decoction high- and low-dosage group increased; compared with the model group, after 3 and 4 weeks of administration, the AI scores of the Yiyiren Decoction high- and low-dosage group and positive group decreased ( P<0.01); the Yiyiren Decoction high- and low-dosage group showed varying degrees of improvement in inflammatory cell infiltration, synovial/fibrous tissue proliferation, and bone and cartilage structure damage in the ankle joint; compared with the model group, the levels of pro-inflammatory cytokines TNF-α and IL-1β in the high and Yiyiren Decoction low-dosage groups decreased ( P<0.01), while the levels of IL-4 and IL-10 increased ( P<0.01); the mRNA level of MMP-3 in synovium decreased ( P<0.05 or P<0.01), while the mRNA level of TIMP-1 increased ( P<0.05 or P<0.01). Conclusion:Yiyiren Decoction can improve the joint symptoms of CIA rats with cold-dampness obstruction, and its preventive and therapeutic effects may be related to correcting the imbalance of pro-inflammatory/anti-inflammatory cytokines and MMP-3/TIMP-1, reducing the inflammatory reaction in the joint cavity and the whole body, and inhibiting the metabolic disorder of joint matrix.

The clinical manifestations, biochemical parameters and imaging examination, genetic test results, and treatment of 3 cases of X-linked adrenoleukodystrophy(X-ALD) patients were reviewed and analyzed, and the structure of adrenoleukodystrophy protein(ALDP) was analyzed. All 3 patients were male. Patients 1 and 2 were childhood cerebral ALD(CCALD), patients 3 was adrenomyeloneuropathy(AMN), and all of them were misdiagnosed at early stage. Brain magnetic resonance imaging(MRI), and hematologic examinations showed the neurological demyelination of X-ALD, adrenocortical insufficiency, and accumulation of very long chain fatty acids(VLCFAs). Sequencing of ABCD1 gene revealed 3 new pathogenic mutations[c.910delins22(p.A304delins8), c. 887A>C(p.Y296S), and c. 1451_1481del(p.P484fs)], which affected the key structure of ALDP and led to the disease. Patients 1 and 2 received hematopoietic stem cell transplantation, and their condition continued to progress after surgery. Patient 3 was in stable condition. The misdiagnosis rate of X-ALD is high, clinicians should be vigilant. In this study, 3 new mutations were found, which expanded the ABCD1 gene mutation spectrum in patients with X-ALD. It is important to note that early identification and early diagnosis of X-ALD should be made to reduce misdiagnosis and mistreatment.

Acute intermittent porphyria(AIP) is a rare inherited metabolic disease that can cause severe and fatal acute attacks. This article shares the treatment and management of a severe AIP patient. It is proposed that (1) avoiding incentives is essential; (2) emotional problems easily overlooked should be paid attention; (3) long-term follow-up and patient education can improve the prognosis. The patient underwent renal biopsy during the remission period. We found a red-brown-yellow-white refractive index crystal under a polarized light microscope that had not been reported in the previous literature, which was speculated to be a porphyrin crystal.

Acute intermittent porphyria (AIP) is a rare disease caused by autosomal dominant inheritance caused by mutations in PDGD/ HMBS gene. Clinical manifestations include severe abdominal pain, intestinal paralysis, limb weakness, epilepsy and psycho-emotional abnormalities. Due to the rarity of the disease and insufficient awareness of medical staff, the rate of clinical misdiagnosis is extremely high. Psycho-emotional abnormality is an important clinical manifestation of AIP and a common cause of acute attacks, but the current clinical attention is far from enough. This article reviews the current situation of anxiety, depression and other psycho-emotional abnormalities, quality of life, pain, fatigue, sleep, fear of disease progression, disease stigma, psychological pain and other indicators of AIP patients, in order to provide directions for improving domestic medical staff's medical care for AIP patients and to provide a basis for preventing attacks, reducing complications and improving prognosis.

The etiology of 46, XY disorders of sex development is complex and the clinical manifestations are various. Patients with a female phenotype often present with primary amenorrhea during adolescence, which is difficult to find. We analyze the clinical features of 3 cases of female phenotype diagnosed by gene sequencing. The pathogenesis, clinical manifestations, diagnosis, and treatment were reviewed.

Objective:To explore the effect of paradoxical intention training on the sleep quality, negative emotion and quality of life of elderly patients with obstructive sleep apnea syndrome (OSAS) .Methods:From March 2018 to February 2020, convenience sampling was used to enroll 130 elderly OSAS patients admitted to the First Affiliated Hospital of Zhengzhou University. Patients were randomly divided into control group and observation group, with 65 cases in each group. Control group implemented routine nursing, while observation group conducted paradoxical intention training based on routine nursing. Pittsburgh Sleep Quality Index (PSQI) , Hospital Anxiety and Depression Scale (HADS) , Calgary Sleep Apnea Quality of Life Index (SAQLI) were used before and after the intervention to compare the sleep quality, psychological status and quality of life between two groups.Results:After one week of intervention, the score of PSQI, anxiety subscale (HADS-A) , depression subscale (HADS-D) of observation group were (7.08±2.70) , (6.25±1.20) and (6.34±1.24) respectively, lower than those of control group, the differences were statistically significant ( t=4.871, 9.439, 8.754; P<0.01) . After the intervention, the total score of SAQLI in observation group was (4.87±0.35) and that in control group was (4.22±0.25) , the difference was statistically significant ( t=12.184, P<0.01) . Conclusions:Paradoxical intention training can help improve the sleep quality, psychological conditions and quality of life of elderly OSAS patients.

Objective To study the effect and mechanism of Dl-3-n-butylphthalide(NBP) on mem-ory and learning ability in type 2 diabetes model db/db mice. Methods Sixteen male db/db mice were ran-domly divided into the NBP group and diabetes group,with 8 mice in each group. Eight male db/m mice of the same age were treated as the control group. NBP group was given NBP by gavage,while diabetes group and control group were given equal volume vegetable oil by gavage. After 6 weeks treatment,Morris water maze was used to examine the spatial memory and learning ability of the mice in each group. The changes of long-term potentiation ( LTP) in the hippocampus area of mice were detected by electrophysiological tech-niques. RT-PCR and Western blot were employed to measure expressions of VEGF,caspase-3,and Aβ1-42 in hippocampus of mice. Results Compared with the control group((21. 49±4. 41)s),average escape la-tency of day 5 in the diabetes group and NBP group were increased significantly ((51. 69±5. 45)s,(26. 92± 4. 76)s,t=9. 21,2. 35,both P<0. 05). Compared with the control group(7. 00±0. 60),the number of cross-ing the target platform in the diabetes group and NBP group were decreased significantly(2. 34± 0. 27), (4. 95±0. 54),t=-6. 56,-2. 49;both P<0. 05). Compared with the control group((255. 90±54. 24)%), LTP level in hippocampus of the diabetes group and NBP group were significantly decreased ( 130. 97 ± 14. 08)%,(176. 17 ± 18. 96)%,t=-4. 25,-2. 38; both P<0. 05). The relative expression of VEGF, caspase-3,and Aβ1-42 in the diabetes group and NBP group were significantly increased compared with those of the control group (t=4. 59,8. 42;7. 36,3. 85;3. 84,2. 11;all P<0. 05). Compared with the diabetes group,the escape latency of day 5,the number of crossing the target platform and LTP level were improved in the NBP group (t=-7. 25,4. 06,3. 25;all P<0. 05). The decreased expression of caspase-3,Aβ1-42 and increased expression of VEGF were reversed after NBP treatment in db/db mice (t=-4. 14,-2. 31,3. 42;all P<0. 05). Conclusion NBP might improve cognitive function and LTP by exerting anti-apoptosis effect through inhibiting the deposition of Aβ1-42 and upregulating VEGF expression in hippocampus of db/db mice.

To explore the present status of fluid therapy and clinical outcome in critically ill patients in intensive care units (ICU).ICU patients consecutively admitted to our ICU were prospectively enrolled.Patients' demographics,laboratory data,fluid record and clinical outcome were collected.Fluid intake quantity of all patients was at peak on the fifth day which was 2 806 (1 997,3 582)ml.From the fourth day in ICU,fluid balance started to benegative as-84 (-1 127,612)ml and gradually increased.Crystalloid solution was the main components.For treatment purposes,medication injections and nutrients were major fluids.Positive correlations were found between total fluid intake quantity,total crystalloid volume,total colloidal volume and hospital stay,ICU stay,duration of intubation (r values as 0.211,0.686,0.282,0.155,0.506,0.174,0.209,0.072,0.292,respectively P＜0.05).Moreover,positive correlations were also demonstrated between total colloidal volume and total bilirubin,direct bilirubin,alanine transaminase,aspartate transaminase,blood urea nitrogen,serum creatinine (r values as 0.196,0.242,0.190,0.335,0.284,0.223,respectively P＜0.05).

Objective To investigate the diagnostic value of neuron-specific enolase(NSE),central nervous system specific protein (S100β),interleukin-6 (IL-6) in sepsis-associated encephalopathy (SAE).Methods Clinical data of patients admitted to ICU and diagnosed with sepsis were collected from January 2015 to June 2016 in Xiangya Hospital,Central South University.SAE was defined as cerebral dysfunction in the presence of sepsis that also fulfilled the exclusion criteria.The acute physiology and chronic health score (APACHE Ⅱ),sequential organ failure assessment (SOFA),NSE,S100β,IL-6,ICU stay time and 28-day mortality were compared between the two groups.NSE,S1003 and IL-6 were measured on the 1 st and 3rd day in ICU to determine the optimal cut-off value of SAE.Results Among 59 enrolled patients,36 were assigned to SAE group while 23 were non-SAE group.The SAE group had a significantly higher APACHE Ⅱ and SOFA scores,as well as the length of ICU stay (P ＜ 0.01).The levels of NSE,S1003 and IL-6 in the two groups both increased on the 1st day,and decreased on the 3rd day.The level of NSE on the 1st day [19.28 (13.00,30.52) μg/L vs 16.61 (7.58,22.01 μg/L)] and the 3rd day[16.03 (9.40,21.29) μg/L vs 11.39(8.49,15.00) μg/L,P=0.029],IL-6 on the 1st day[676.25(81.34,5 000.00) mg/L vs [209.10(42.27,648.20) mg/L,P =0.005] and the 3rd day [157.10 (72.85,687.63) mg/L vs 55.92 (31.62,177.00) mg/L,P =0.026] of SAE group was significantly higher than those of non-SAE group.However S100β between groups on the 1st day [0.33(0.15,0.54) μg/L vs 0.23(0.16,0.53) μg/L] and the 3rd day[0.19(0.10,0.29) μg/L vs 0.10(0.05,0.17) μg/L] was neither significant (P ＞0.05).The diagnostic values for SAE of NSE,S1003 and IL-6 were 14.36 μg/L,0.14 μg/L and 91.305 mg/L with sensitivity 61.1％,61.1％,72.2％ and specificity 73.9％,69.6％,69.6％,respectively.The diagnostic AUC of NSE and IL-6 combination was 0.774,95％ CI 0.651-0.896.Conclusion All sepsis patients have different degrees of brain injury.NSE combined with IL-6 on the 3rd day in ICU demonstrates the diagnostic significance of SAE.

Objective:To investigate the effects of Cordyceps sinensis (CS) on cellular apoptosis and Sirt1 expression in HK2 cells followed by ischemia-reperfusion (I/R).Methods:HK2 cells were incubated with different concentrations of CS (10,20,40,80,160,320 mg/L) for 24 hours,and the optimal concentration of CS was selected by measuring cell proliferation.The confluent HK2 cells were incubated with 0.01 μmol/L antimycin A for 2 hours to induce ischemia in vitro,and then the reperfusion was achieved by incubating cells with glucose-replete complete growth medium for 24 hours.HK2 cells were divided into 4 groups:a control group,an I/R group,an I/R+CS (160 mg/L) group,and an I/R+CS (160 mg/L)+Sirtinol (25 μtmol/L) group.Twenty-four hours later,total RNA and protein were collected.The cell proliferation was evaluated by MTT assay;the mRNA and protein expression of Sirtl and the cleaved caspase-3 were measured by qRT-PCR and Western blot,respectively.The cellular apoptosis rate was determined by Annexin V-FITC/PI double staining and flow cytometry.Results:Certain concentrations (10-160 mg/L) of CS did not show effect on the proliferation of HK2 cells (P＞0.05),while 320 mg/L of CS inhibited cell proliferation significantly (P＜0.01);compared with the control group,the mRNA and protein expressions of Sirtl and the cleaved caspase-3 in the I/R group were up-regulated (P＜0.01) and the apoptosis rate was extremely high;compared with the I/R group,CS significantly up-regulated Sirt1 mRNA and protein expression (P＜0.01) while down-regulated cleaved caspase-3 mRNA and protein levels (P＜0.01),and reduced apoptosis rate (P＜0.05).The effects of CS were blocked in the presence of sirtinol,an inhibitor of CS.Conclusion:CS protects HK2 cells from I/R injury through activation of Sirt 1 pathway.