Objective:To observe the effects of Qizhi Tongluo Prescription on renal interstitial fibrosis in rats with membranous nephropathy based on the Shh/Gli1 signaling pathway; To explore its intervention mechanism.Methods:Totally 60 male SD rats were divided into blank group ( n=10) and model group ( n=50) using random number table method. The model of membranous nephropathy was established according to the modified Border method. The successfully modeling rats were divided into model group, benazepril group and Qizhi Tongluo Prescription low-, medium- and high-dosage groups using random number table method. Benazepril group was gavaged with benazepril hydrochloride 10 mg/kg, Qizhi Tongluo Prescription low-, medium- and high-dosage groups were gavaged with Qizhi Tongluo Prescription solution 1.22 g/kg, 2.43 g/kg and 4.86 g/kg, and blank group and model group were gavaged with equal volume of normal saline, once a day, for 4 weeks. The 24-hour urine was collected to detect the 24-hour urinary protein quantification, and the blood was taken from the abdominal aorta to detect the levels of total cholesterol (TC), triglyceride(TG), and serum albumin(ALB); the pathological changes of rat kidney were observed by light microscope and transmission electron microscope; the protein expressions of sonic hedgehog factor (Shh), zinc finger protein 1 (Gli1) and α-smooth muscle actin (SMA) in renal tissues were detected by immunohistochemistry; the protein expressions of Shh, Gli1, α-SMA, TGF-β1, Collagen Ⅳ and plasminogen activator inhibitor-1 (PAl-1) in renal tissues were detected by Western blot. Results:Compared with the model group, the quantitative level of 24-hour urinary protein of rats in each administration group decreased ( P<0.05), serum TC and TG levels increased ( P<0.05), ALB level decreased ( P<0.05), the positive expressions of Shh, Gli1, α-SMA protein in renal tissue decreased ( P<0.05), and the protein expressions of Shh, Gli1, α-SMA, Collagen Ⅳ, TGF-β1, PAI-1 in renal tissue decreased ( P<0.05). Conclusion:Qizhi Tongluo Prescription can improve renal interstitial fibrosis in membranous nephropathy rats, possibly by inhibiting the Shh/Gli1 signaling pathway to delay renal interstitial fibrosis.

Objective To compare the efficacy of tegoprazan and esomeprazole in treatment of reflux esophagitis(RE)and analyze the influencing factors for treatment failure.Methods A total of 120 RE patients were selected as study subjects and divided into control group(treated with esome-prazole)and observation group(treated with tegoprazan)using random number table method,with 60 cases in each group.The clinical efficacy and gastroscopic efficacy of the two groups were com-pared.Based on the gastroscopic assessment results,the patients were divided into failure group(26 cases)and success group(94 cases).The clinical data of the failure group and the success group were collected and compared.Multivariate Logistic regression analysis was used to screen the influen-cing factors for treatment failure in RE patients.Results The total clinical effective rate in the ob-servation group was 93.33％(56/60),which was higher than 76.67％(46/60)in the control group(P＜0.05).The total effective rate under gastroscopy in the observation group was 88.33％(53/60),which was higher than 68.33％(41/60)in the control group,and the difference was statistically significant(P＜0.05).The proportions of patients with body mass index(BMI)＞28 kg/m2,diabe-tes,a family history,Helicobacter pylori(Hp)infection,Los Angeles classification(LA classifica-tion)of gastroesophageal reflux disease(GERD)grade C to D,and treated with esomeprazole in the failure group were all higher than those in the success group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that BMI＞28 kg/m2,con-comitant diabetes,LA classification grade C to D,and treatment with esomeprazole were all inde-pendent risk factors for treatment failure in RE patients(P＜0.05).Conclusion Tegoprazan has a significant clinical effect in treatment of RE,and its efficacy is superior to that of esomeprazole.BMI＞28 kg/m2,concomitant diabetes,LA classification grade C to D,and treatment with esome-prazole are all risk factors for treatment failure in RE patients.

Objective:To observe the efficacy of cosmetic suturing techniques combined with topical recombinant human basic fibroblast growth factor (rh-bFGF) in repairing facial trauma.Methods:A prospective study was conducted on 140 patients with facial trauma admitted to the Department of Burn and Plastic Surgery, Northern Jiangsu People＇s Hospital from January to December 2022. Patients were divided into two groups based on different treatment methods using a random number table method: treatment group (70 cases), including 38 males and 32 females aged 3 to 54 (23.1±8.2) years, received cosmetic suturing techniques combined with topical rh-bFGF for wound repair; control group (70 cases), including 36 males and 34 females aged 2 to 49 (22.3±7.5) years, only received cosmetic suturing techniques for wound repair. Patients were followed up 2 weeks post-surgery to evaluate wound healing quality. Patient satisfaction was assessed using the visual analogue scale (VAS). Six months post-surgery, scar conditions were evaluated using the Vancouver scar scale (VSS).Results:In the treatment group, 65 cases were directly sutured, and 5 cases were repaired with skin flaps, with a first-class healing rate of 100% (70/70). In the control group, 66 cases were directly sutured, and 4 cases were repaired with skin flaps, with a first-class healing rate of 91.4% (64/70). The first-class healing rate in the treatment group was higher than that in the control group, with a statistically significant difference ( P=0.037). Two weeks post-surgery, the VAS score for surgical satisfaction in the treatment group was (1.13±0.52) scores, which was lower than that in the control group (2.56±1.32) scores, with a statistically significant difference ( P<0.001). Six months post-surgery, the VSS score for the treatment group was (2.49±1.27) scores, which was lower than that in the control group (4.67±1.93) scores, with a statistically significant difference ( P<0.001). Conclusions:In repairing facial trauma, the combination of cosmetic suturing techniques and topical rh-bFGF can improve wound healing quality, reduce wound scarring, and enhance patient satisfaction with surgery.

The vagina contains at least a billion microbial cells,dominated by lactobacilli.Here we perform metagenomic shotgun sequencing on cervical and fecal samples from a cohort of 516 Chinese women of reproductive age,as well as cervical,fecal,and salivary samples from a second cohort of 632 women.Factors such as pregnancy history,delivery history,cesarean section,and breastfeeding were all more important than menstrual cycle in shaping the microbiome,and such information would be necessary before trying to interpret differences between vagino-cervical micro-biome data.Greater proportion of Bifidobacterium breve was seen with older age at sexual debut.The relative abundance of lactobacilli especially Lactobacillus crispatus was negatively associated with pregnancy history.Potential markers for lack of menstrual regularity,heavy flow,dysmenor-rhea,and contraceptives were also identified.Lactobacilli were rare during breastfeeding or post-menopause.Other features such as mood fluctuations and facial speckles could potentially be predicted from the vagino-cervical microbiome.Gut and salivary microbiomes,plasma vitamins,metals,amino acids,and hormones showed associations with the vagino-cervical microbiome.Our results offer an unprecedented glimpse into the microbiota of the female reproductive tract and call for international collaborations to better understand its long-term health impact other than in the settings of infection or pre-term birth.

Objective To study perioperative period conditions of total and partial colpocleisis with severe pelvic organ prolapse(POP)in elderly patients. Methods From Jan. 2014 to Oct. 2017286 severe POP elderly patients underwent total or partial colpocleisis. The mean age was(76.0±5.1)years(60-90 years). Of which,220 patients(76.9％, 220/286)presented more than one kind of medical disease. The operative time, intraoperative blood loss, hospital stay after surgery, postoperative complications, preoperative urinary dysuria symptoms of total and partial colpocleisis in treatment of 286 patients were analyzed. Results In 286 patients, 172 patients(60.1％)underwent total colpocleisis and 114 patients(39.9％) underwent partial colpocleisis. Totally 48 patients(16.8％)in 286 patients underwent anti-urinary incontinence procedure. The mean operating time of 286 patients was(67 ± 22)minutes, the mean blood loss was(52 ±57)ml, the mean hospital stay after surgery was(5.9 ± 1.9)days(2-16 days). The rate of postoperative complications was 8.7％(25/286). Those complications including 1 case of bladder injury during operation, 3 cases of postoperative pelvic hematoma, 1 case of intestinal obstruction, 5 cases of atrial fibrillation, 10 cases of postoperative morbidity, 3 cases of pulmonary embolism, 1 case of lower limb thrombosis, 1 case of urinary retention underwent electrical stimulation treatment because of ineffective application of urinary retention catheter. The mean operating time was(67±22)minutes in total colpocleisis and(68±20) minutes in partial colpocleisis(P>0.05), the mean blood loss was(58±62)ml in total colpocleisis and(41± 45)ml in partial colpocleisis(P>0.05), the mean hospital stay after surgery was(5.9 ± 1.9)days in total colpocleisis and(6.0 ± 1.8)days in partial colpocleisis(P>0.05), the rate of post operative complications was 8.1％(14/172) in total colpocleisis and 9.6％(11/114)in partial colpocleisis(P>0.05), respectively;those four of comparisons showed no significant difference. There were 129 patients(45.1％, 129/286)with voiding difficulty before surgery;the mean postvoid residual volumes of the above two operation types of people after operation were(35 ± 43)and(34 ± 41)ml, which showed no significant difference(P>0.05). Conclusions Colpocleisis is a safe and effective management in selected elderly patients with severe POP, who no longer desire to maintain vaginal coital function. There is no significant difference in the perioperative period conditions between total and partial colpocleisis. The choice of surgical procedure is based on factors such as the presence or absence of malignancy in the uterus, age and willingness of the patient, and general condition.

Objective: To determine the screening and early detection reference age for individuals with family history of cancer in either one of the parents. Methods: We examined the family history of 33 200 subjects who visited the Department of Cancer Prevention, National Cancer Center and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2008 and March 2018 for cancer screening and early detection. The age differences between the subjects in the research population were analyzed using an independent t-test. All statistical analysis was performed using IBM SPSS Statistics for Windows version 24.0 (IBM Corp., Armonk, NY, USA). Results: We documented 480 families in which fathers and one or more of their children were diagnosed with malignancies, attributing to 614 father-child pairs. We also documented 476 families with mothers and one or more of their children diagnosed with malignancies, attributing to 614 mother-child pairs. In total, we included 956 families in our study with a total of 505 sons and 723 daughters diagnosed with cancer during the study period. In the father-child group the average age at diagnosis for fathers, sons, and daughters were 66.6±10.8, 56.6±11.7, and 51.7±11.7 years, respectively. Sons and daughters were diagnosed with malignancy 10.0 and 14.9 years earlier than their fathers, respectively (P<0.001). Daughters developed malignancies approximately 5 years earlier than sons in the father-child group (P<0.001). In the mother-child group, the average age at diagnosis for mothers, sons, and daughters were 65.8±12.2, 57.8±12.2, and 52.3±12.4 years, respectively. Mothers were diagnosed with malignant disease 8 years later than their sons (P<0.001) and 13.5 years later than their daughters (P<0.001). Interestingly, daughters developed malignant diseases 5.5 years earlier than sons even in this group (P<0.001). Average age at diagnosis for subjects whose fathers and mothers developed malignancy before 50 years was 4.8 years and 4.4 years earlier than those whose fathers and mothers developed malignancy after 50 years old (P<0.05, P<0.001). Sons and daughters were diagnosed with lung cancer 9.3 and 12.6 years earlier than the fathers, and 10.2 and 13.6 years earlier than the mothers, respectively (P<0.001).The daughters in the mother-children group and the father-daughter group were diagnosed with breast cancer 10.5 and 11.1 years earlier than the mothers in the mother-child group (P<0.001). Conclusions Children develop malignancy earlier than their parents in families with cancer in parents and children. Hence, individuals with a family history of cancer in either of their parents should undergo interventions for cancer screening and early detection at a relatively earlier age compared to the initial screening age recommended by conventional screening guidelines for certain cancers.

Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.
Anterior Cerebral Artery ; Basal Ganglia ; Child ; Diagnosis, Differential ; Extremities ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Meningioma ; Neurologic Examination ; Paresis ; Radiotherapy ; Rehabilitation ; Vomiting

Objective To investigate the association between DNA methylation of matrix metallo-proteinase 9(MMP-9) gene and cognitive function including continuous attention,cognitive flexibility and visuospatial memory in patients with chronic schizophrenia.Methods 71 male schizophrenia patients and 69 healthy controls were recruited and detected their cognitive function.Pyrosequencing was used to determine DNA methylation at CpG site in exon 4 and exon 5 of MMP-9 gene.RT-qPCR was used to detect MMP-9 gene expression.Clinical symptoms were assessed by BPRS.Results (1) Cognitive function including Trail Making Test A,Trail Making Test B,Stroop words only,Stroop colors only,Stroop interference,Spatial Processing Block design and Block Design all scores were significantly lower in schizophrenia patients with schizophrenia than those in health controls (P＜0.01);(2) The MMP-9 gene expression in PBMCs was significantly higher in schizophrenia patients (1.31± 0.48) than that in health control (1.11 ± 0.45,P＜ 0.05).The DNA methylation of CpG4-1,CpG4-2,CpG4-3,CpG4-4,CpG4-5,CpG5-1,CpG5-2,CpG5-4 of MMP-9 gene in schizophrenia patients were lower than those in health controls (P＜0.01).(3)DNA methylation of CpG4-3 was positive correlated with Stroop interference (r=0.324,P＜0.01) in health controls.Correlation analysis showed that DNA methylation of CpG4-1 was negatively correlated with sustained attention function (r =-0.329,P＜0.01),cognitive flexibility (r =-0.337,P＜ 0.01) and visuospatial memory (r =-0.308,P＜ 0.05) in schizophrenia patients.There were positive correlations between DNA methylation of CpG4-5 (r=0.305,P＜0.05),CpG5-1 (r=0.262,P＜0.05),CpG5-3 (r=0.260,P＜0.05),average DNA methylation at exon 5 (r=0.288,P＜0.05) and visuospatial memory.DNA methylation of CpG5-4 was positive correlated with sustained attention function (r=0.251,P＜0.05) and visuospatial memory (r=0.350,P＜ 0.01) respectively.Conclusion Male patients with schizophrenia suffer from extensive cognitive impairment,and methylation of MMP-9 gene may be associated with cognitive impairment of schizophrenia.

Objective To investigate the anatomical basic of extensor carpi radialis brevis (ECRB) tendon transferring to extensor pollicis longus (EPL) tendon.Methods Twelve sides of ECRB and EPL in fresh adult cadaver's forearms were collected,and the anatomical model of ECRB transferring to EPL was set up in all the forearms.The anatomical parameters of EPL were measured before and after anatomical model established.Results The effective transferring length of ECRB was (3.5±0.8)cm;the maximum circumferential of ECRB and EPL were (8.5±0.8)cm and (3.6±0.3)cm (P ＞0.05),the ratio of muscle cross-sectional area was 5.57;After the anatomical model setting up,anatomic angles of EPL was (30±7)°,which was a decrease of (20±5) ° comparing with the preoperative angel of (50±9) ° (P ＞0.05);Thumb extension angle was (50± 12) °,which was a decrease of (8±3) ° comparing with the preoperative angel of (58 ± 16) ° (P＜0.05);The dorsal extension angle of first metacarpal was (12±5)o,which was a decrease of (3± 2) o comparing with the preoperative angle (15±8)° (P＞0.05);Thumb tip lifting height was (2.3±0.9) c m,which was a decrease of (1.2±0.6)cm comparing with the preoperative height (3.5±1.2)cm (P ＞0.05).Conclusion Based on the measurement of the anatomic parameters of ECRB and EPL,the ECRB has enough length and muscle force to reconstruct the function of EPL.The thumb had a good extension appearance and accorded with the rule of biomechanics after setting up the anatomical model of ECRB transferring to EPL.This study will provide the anatomical evidence for further clinical application

Objective To investigate the clinical features and mechanism and feasibility of plasma exchange (PE) in treating systemic lupus erythematosus (SLE) complicated with acute pancreatitis (AP). Methods A retrospective analysis of SLE associated with AP was done based on the HIS in Tongji Hospital. Totally 24 SLEAP patients were admitted to Tongji hospital from March 2006 to May 2014. Patientsˊ serum amylase, lipase and interleukin (IL)-6 concentration were measured before and after plasma exchange. According to different therapy strategy, patients were divided into two groups. Fifteen patients treated with plasma exchange combination with glucocorticosteroid (GC) were classified as Group A, the other 9 patients who were treated with GC only were classified as group B. At baseline and after treatment, the serum lipid concentration, average daily glucocorticosteroid dosage between group A and B were compared with ANOVA and serum IL-6 concentration between roup A and B were compared with Wilcoxon rank test. Results SLEDAI score in group A patients at baseline (16 ±5) was no statistically different from that in group B (18 ±4) (t=1.31, P=0.320). Average daily GC dosage in group A 31.0 (20.50, 30.08)mg/d was significantly less than that in group B 47.85 (45.58, 59.23) mg/d (Z=35.50, P= 0.002). Serum IL-6 levels in group A and B at baseline was not significantly different 13.14 (11.12,16.57) mg/L vs 14.63 (11.37, 16.37) mg/L (Z=12.20, P=0.300), after 2 weeks treatment, IL-6 level, which was 9.16 (7.93, 10.75) mg/L, decreased significantly in group A while it didnˊt show tendency of decrease in group B, which was 13.62(9.29, 17.63) mg/L (Z=28.50, P=0.039). Serum lipid concentration after 2 weeks therapy in Group A [TC=(5.02 ±0.53) mmol/L, TG=(1.46 ±0.44) mmol/L] decreased significantly compared to baseline [TC=(6.11±0.50) mmol/L, TG=(2.14±0.65) mmol/L] (F=4.46, P=0.010; F=6.09, P=0.002), while similar tendency wasnˊt observed in group B (F=1.57, P>0.05). Conclusion PE combined with GC could lower serum IL-6 levels, reduce the amount of GC and lower serum lipid to improve prognosis. Therefore it might be a safe and effective way and is worthy of continuing to explore its feasibility.