Objective To observe the clinical efficacy of modified Shoutai Pills in the treatment of polycystic ovary syndrome(PCOS)complicated with recurrent spontaneous abortion(RSA).Methods Ninety-six patients with PCOS complicated with RSA of kidney deficiency and blood stasis syndrome admitted to Lishui Hospital of Traditional Chinese Medicine from January 2021 to January 2022 were randomly divided into the observation group and the control group,with 48 cases in each group.The control group was treated with progesterone,aspirin and low molecular weight heparin,while the observation group was treated with modified Shoutai Pills on the basis of treatment for the control group.The course of treatment covered one month and then the follow-up lasted for one year.The changes of traditional Chinese medicine(TCM)syndrome scores,ovarian reserve function indicators of antral follicle count and mean ovarian volume,and coagulation and fibrinolysis indicators of fibrinogen(FIB),activated partial thromboplastin time(APTT),prothrombin time(PT),and D-dimer(D-D)level before and after the treatment in the two groups were observed.After treatment,the clinical efficacy,total incidence of adverse reactions and pregnancy outcome of the two groups of patients were compared.Results(1)After one month of treatment,the total effective rate of the observation group was 95.83%(46/48),and that of the control group was 72.92%(35/48);the comparison between the two groups showed that the overall efficacy(tested by Ridit test)and the total effective rate(tested by chi-square test)of the observation group were significantly superior to those of the control group(P<0.05).(2)After treatment,the scores of spontaneous abortion frequency and TCM symptoms such as pain in the lower abdomen,fatigue and weakness,and dizziness and tinnitus in the two groups were decreased compared with those before treatment(P<0.05),and the decrease of the scores in the observation group was significantly superior to that in the control group(P<0.05).(3)After treatment,ovarian reserve function indicators of antral follicle count and mean ovarian volume in the two groups were 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).(4)After treatment,coagulation and fibrinolysis indicators such as FIB,APTT,PT,and D-D in the two groups were 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)The total incidence of adverse reactions in the observation group was 6.25%(3/48),while that in the control group was 10.42%(5/48),and the comparison between the two groups showed that the difference was not statistically significant(P>0.05).(6)The rate of full-term delivery in the observation group was 87.50%(42/48),higher than that in the control group[45.83%(22/48)];the preterm birth rate and abortion rate of the observation group were 8.33%(4/48)and 4.17%(2/48),respectively,lower than those of the control group[all being 27.08%(13/48)],with the differences being statistically significant(P<0.05 or P<0.01).Conclusion Modified Shoutai Pills can effectively improve the ovarian function of patients with PCOS complicated with RSA,correct the hypercoagulable state,relieve abdominal pain and other symptoms,reduce the rate of preterm birth and abortion,and no obvious adverse reactions occurred in the patients during treatment.

Objective To investigate the relationship between interleukin-1β (IL-1β) and miR-185-5p in the process of joint injury in acute gouty arthritis (AGA). Methods The serum miR-185-5p levels of 89 AGA patients and 91 healthy volunteers were detected by real-time quantitative PCR. The correlation between miR-185-5p expression level and VAS score or IL-1β expression level was evaluated by Pearson correlation coefficient method. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of miR-185-5p in AGA. THP-1 cells were induced by sodium urate (MSU) to construct an in vitro acute gouty inflammatory cell model. After the expression level of miR-185-5p in THP-1 cells was upregulated or downregulated by transfection of miR-185-5p mimics or inhibitors in vitro, inflammatory cytokines of THP-1 cells, such as IL-1β, IL-8 and tumor necrosis factor α (TNF-α), were detected by ELISA. The luciferase reporter gene assay was used to determine the interaction between miR-185-5p and the 3'-UTR of IL-1β. Results Compared with the healthy control group, the expression level of serum miR-185-5p in AGA patients was significantly reduced. The level of serum miR-185-5p was negatively correlated with VAS score and IL-1β expression level. The area under the curve (AUC) was 0.905, the sensitivity was 80.17% and the specificity was 83.52%. Down-regulation of miR-185-5p significantly promoted the expression of IL-1β, IL-8 and tumor necrosis factor (TNF-α), while overexpression of miR-185-5p showed the opposite results. Luciferase reporter gene assay showed that IL-1β was the target gene of miR-185-5p, and miR-185-5p negatively regulated the expression of IL-1β. Conclusion miR-185-5p alleviates the inflammatory response in AGA by inhibiting IL-1β.
Humans ; 3' Untranslated Regions ; Arthritis, Gouty/genetics* ; Interleukin-1beta/genetics* ; Interleukin-8 ; Luciferases ; MicroRNAs/genetics* ; Tumor Necrosis Factor-alpha

The application of combination antiretroviral therapy(cART)has significantly prolonged the life expectancy of patients infected with human immunodeficiency virus(HIV).However,viral infection and adverse reactions of cART drugs make patients more prone to organ failure.Solid organ transplantation has become a standard treatment for HIV-infected patients with end-stage organ failure.Nevertheless,among HIV-positive soild organ transplant recipients,multiple problems remain to be resolved,such as increased incidence of graft rejection,increased infection risk,drug toxicity and drug interaction between cART therapy and immunosuppressive drugs,etc.It is extremely challenging to deliver appropriate management for HIV-positive soild organ transplant recipients.Therefore,the application of immune induction therapy,calcineurin inhibitors,mammalian target of rapamycin(mTOR)inhibitors and other immunosuppressive drugs in HIV-positive soild organ transplant recipients was reviewed,aiming to provide reference for subsequent management of immunosuppression in HIV-positive soild organ transplant recipients.

Objective:To analyze the fail mode of neoadjuvant therapy combined with surgery for locally advanced esophageal squamous cell carcinoma (ESCC) after long-term follow-up.Methods:Clinical data of consecutive 238 patients with locally advanced resectable ESCC who underwent neoadjuvant therapy combined with surgery in Zhejiang Cancer Hospital from September 2012 to October 2019 were retrospectively analyzed. The failure mode in the whole cohort was analyzed after long-term follow-up. The overall survival (OS) and disease free survival (DFS) rates were analyzed by Kaplan-Meier method. Survival differences were determined by log-rank test.Results:The pathological complete response (pCR) rate was 42.0% in 238 patients. After a median follow-up of 46.1 months, tumor progression occurred in 96 patients (40.3%), including 25 patients (10.5%) with local recurrence, 61 patients (25.6%) with distant metastases, and 10 patients (4.2%) with simultaneous local recurrence and distant metastases. The median OS and DFS were 64.7 months and 49.9 months. And the 3-, 5-, and 7-year OS and DFS rates were 70.0%, 52.8%, 36.4% and 63.5%, 42.5%, and 30.0%, respectively. The 3-, 5-, and 7-year locoregional recurrence-free survival rates and distant metastasis-free survival rates were 86.0%, 71.4%, 61.2% and 70.6%, 55.9%, 43.0%. Compared with non-pCR patients, the overall progression rate and distant metastasis rate of pCR patients were lower (26.0% vs. 50.7%, 16.0% vs. 32.6%, both P<0.05). And the 3-, 5-, and 7-year OS (83.0% vs. 60.2%, 69.7% vs. 41.7%, 50.4% vs. 27.7%, all P<0.001) and DFS rates (80.4% vs. 51.4%, 63.9% vs. 31.2%, 45.9% vs. 20.3%, all P<0.001) were significantly better in pCR patients. Conclusions:Distant metastasis is the main failure mode of patients with locally advanced ESCC after neoadjuvant therapy. Patients with postoperative pCR can achieve better long-term survival.

Objective To analyze the main active components and potential molecular mechanism of Sophora flavescens against breast cancer based on network pharmacology and molecular docking. Methods The chemical constituents were collected and screened by TCMSP, ETCM database and literature review. The targets of active ingredients were predicted by Swiss Target Prediction database. Breast cancer-related targets were collected by GeneCards, TTD, Drugbank and OMIM. The anti-breast cancer targets of Sophora flavescens were screened by Venny 2.1.0 software. Cytoscape software was used to construct the network diagram of Sophora flavescens-key active ingredients-targets. STRING database was used to analyze the common targets, and PPI network diagram was constructed. GO function enrichment analysis and KEGG pathway enrichment analysis of key target proteins were performed by DAVID database and Hiplot online platform. Schrodinger software was used to calculate the molecular docking between the active ingredients and targets. Molecular biological methods were used to verify the key targets. Results A total of 36 active components with clear structures were screened from Sophora flavescens. 70 anti-breast cancer targets of Sophora flavescens were screened out. 12 core targets including EGFR, AKT1, ESR1, SRC, CYP19A1, AR and ABCB1 participate in endocrine resistance, EGFR tyrosine kinase inhibitors and estrogen signaling pathways in breast cancer. Moreover, the docking score between the core component and the key target AR is the highest. In vitro experiments showed that the extract of Sophora flavescens can inhibit the proliferation of breast cancer cells, induce cell apoptosis and up-regulate AR protein expression. Conclusion It was revealed that Sophora flavescens plays an anti-breast cancer role by regulating complex biological processes through multiple components acting on multiple targets and signaling pathways. The upregulation of AR protein by Sophora flavescens may become a new therapeutic strategy for the treatment of breast cancer.

Objective:To explore the clinicopathological features and prognosis of renal mucinous tubular spindle cell carcinoma (MTSCC).Methods:The clinical data of 16 patients with MTSCC admitted to the First Affiliated Hospital of Zhengzhou University from July 2013 to July 2022 were retrospectively analyzed. There were six male cases and ten female cases. The mean age was (56.4±11.4) years old. Among them, 10 cases were asymptomatic, two complained of hematuria, three complained of lumbar pain, and one complained of lower limb pain. Twelve cases underwent preoperative enhanced CT examination, 6 cases of ultrasound examination, 3 cases of MRI examination, and 1 case of bone scan. Imaging manifestations showed that the masses were round or round-like with clear borders. Two cases combined with hemorrhage and three cases combined with calcification. Five cases showed exophytic growth, 10 cases partially exophytic, and 1 case completely endophytic. The maximum diameter of the tumor was (65.7±27.4) mm. The tumors were located in the left kidney in 11 cases and in the right kidney in 5 cases. The tumors were mildly delayed-enhancing under enhanced CT, long/short T1 signal mixed with long/short T2 signal under MRI, and diffusion-limited high signal under DWI. The tumors were hypoechoic masses without obvious blood flow signals under ultrasound. Twelve cases were diagnosed as renal occupying neoplasms, 2 cases were suggested as lack of blood supply renal tumor, and one was considered renal tumor rupture and bleeding. In one case, a bone scan suggested metastasis to the thoracic spine and pelvis. The metastatic renal tumor was diagnosed, and a renal puncture was performed to clarify the pathology. Eleven patients underwent laparoscopic radical nephrectomy, and 4 patients underwent partial nephrectomy. One case was metastasized without surgery and treated with apatinib mesylate and zoledronic acid.Results:The postoperative pathological specimens showed grayish, grayish-yellow, or grayish-red masses with a soft or medium texture. No perinephric, ureteral, or adrenal invasion was seen in all tumors. Microscopically, the tumor cells were round and ovoid. The tumor cells were arranged in tubular and striated shapes, and mucus pools were locally visible. No sarcomatous component was seen in all tumors. There were 9 patients with pT 1N 0M 0, 6 patients with pT 2N 0M 0, and 1 patient with pT 1N 0M 1. After operation, 2 patients with pT 2N 0M 0, who underwent laparoscopic radical nephrectomy were treated with pazopanib and sunitinib, respectively. All patients were followed up for a median of 50.7(25.8, 75.0)months, 15 patients were free of recurrent metastases, and 1 patient with pre-puncture metastasis died due to tumor progression of multiple pulmonary and bone metastases, with a survival of 16.9 months. Conclusions:Renal MTSCC is rare, mostly found on physical examination, with female patients predominantly, and imaging shows a lack of blood supply tumor. Surgery is the primary treatment method. Partial nephrectomy or radical nephrectomy could be chosen according to the tumor stage, kidney function, and patient's underlying condition, and patients have a good prognosis.

Population aging increases the demand for human aging research and its clinical applications.Traditionally, the chronological age(CA), that is, the age based on the calendar, is used to describe the state of aging.However, the aging process and speed among individuals are not consistent and often show clear individual differences in biological aging.Therefore, CA cannot truly reflect people's conditions of body structure and function, has drawbacks leading to unreliable and wrong assessment, and is unable to accurately describe the human body's state of aging.In recent years, it has been proposed that the biological age(BA)should be used to more comprehensively and accurately describe the stage of human aging.Combining mathematical algorithms with a variety of biomarkers, predictive models can be constructed to quantify BA.These approaches have been increasingly appreciated for their improved accuracy and received further investigation.This article reviews the value of BA, currently commonly used calculation methods and their progress and prospects in healthy aging.

Mendelian randomization is a genetic epidemiological method for confounding adjustment of cross-sectional data by introducing genotypes as instrumental variables of exposure factors and possesses unique advantages for the adjustment of unmeasured and unknown confounding factors.In recent years, Mendelian randomization has been widely used and achieved rapid progress in the etiology research of common diseases in the elderly.This article reviews this method and its application in these diseases, including cardiovascular disease, type 2 diabetes mellitus, osteoporosis, Alzheimer's disease and malignant tumor.

Objective The bispectral index (BIS) was introduced into the sedation strategy of critical patients in intensive care unit (ICU) and replaced the Richmond agitation sedation scale (RASS).The ventilation time,ICU length of stay,and 90-day mortality were compared between the two groups of patients who performed early goal-directed sedation (EGDS) or standard traditional directed sedation (STDS) strategies.Methods A prospective controlled study of severe patients with mechanical ventilation ≥48 h in ICU (20 cases from April 2016 to May 2017,46 cases from June 2017 to April 2018) were randomly divided into EGDS or STDS group.There were no significant differences in age,gender,and acute physiology and chronic health evaluation score Ⅱ (APACHE Ⅱ) score between the two groups in the two periods.The correlation between RASS and BIS was analyzed in the first period.The BIS of the patients in a RASS range of (-2-1) was 73.65 ± 7.87 in the EGDS group,and that of RASS range of (-3--1) was 64.14 ± 7.25 in the STDS group.The above BIS was applied to the two sedation strategies in the second period respectively.The ventilation time,ICU length of stay,and 90-day mortality were recorded.Results There was no significant difference in the ventilation time between the two groups [(164.12 ± 137.96) h and (155.33 ±64.86)h,P =0.08].ICU length of stay of the EGDS group was longer than that of the STDS group.The 90-day mortality of the EGDS group was higher than that of the STDS group.Conclusions Correlations between RASS and BIS were found in this study,and BIS can be used for sedation assessment in ICU patients.Large sample study is still needed to compare EGDS and STDS with BIS.

Objective To investigate and analyze the reasons for the omission of adjuvant radiotherapy after breast-conserving surgery (BCS) in patients with breast cancer.Methods The clinicopathologial characteristics and socioeconomic data of 55 breast cancer patients undergoing BCS without postoperative adjuvant radiotherapy in our hospital from 2012 to 2016 were retrospectively analyzed.Results Among the 55 patients who did not receive radiotherapy,25 patients were due to low local recurrence risk,12 patients were due to economic or family reasons,12 patients were due to fear of adverse reactions of radiotherapy,and 5 patients were not recommended by primary physicians for radiotherapy.In addition,3 cases with multiple distant metastases and 3 cases with concomitant thyroid cancer didn't received radiotherapy.Conclnsions Low risk local recurrence is the main reason for the omission of adjuvant radiotherapy,followed by the fear of radiation-induced toxicity and poor financial support.Patient education and medical insurance may improve the adjuvant radiotherapy compliance.