OBJECTIVE: To develop and validate a user-friendly risk score for older mitral regurgitation (MR) patients, referred to as the Elder-MR score. METHODS: The China Senile Valvular Heart Disease (China-DVD) Cohort Study functioned as the development cohort, while the China Valvular Heart Disease (China-VHD) Study was employed for external validation. We included patients aged 60 years and above receiving medical treatment for moderate or severe MR (2274 patients in the development cohort and 1929 patients in the validation cohort). Candidate predictors were chosen using Cox's proportional hazards model and stepwise selection with Akaike's information criterion. RESULTS: Eight predictors were identified: age ≥ 75 years, body mass index < 20 kg/m², NYHA class III/IV, secondary MR, anemia, estimated glomerular filtration rate < 60 mL/min per 1.73 m², albumin < 35 g/L, and left ventricular ejection fraction < 60%. The model displayed satisfactory performance in predicting one-year mortality in both the development cohort (C-statistic = 0.73, 95% CI: 0.69-0.77, Brier score = 0.06) and the validation cohort (C-statistic = 0.73, 95% CI: 0.68-0.78, Brier score = 0.06). The Elder-MR score ranges from 0 to 15 points. At a one-year follow-up, each point increase in the Elder-MR score represents a 1.27-fold risk of death (HR = 1.27, 95% CI: 1.21-1.34, P < 0.001) in the development cohort and a 1.24-fold risk of death (HR = 1.24, 95% CI: 1.17-1.30, P < 0.001) in the validation cohort. Compared to EuroSCORE II, the Elder-MR score demonstrated superior predictive accuracy for one-year mortality in the validation cohort (C-statistic = 0.71 vs. 0.70, net reclassification improvement = 0.320, P < 0.01; integrated discrimination improvement = 0.029, P < 0.01). CONCLUSIONS The Elder-MR score may serve as an effective risk stratification tool to assist clinical decision-making in older MR patients.

Leukemia inhibitory factor (LIF) contributes to the neuroprotection by neural stem cells (NSCs) after ischemic stroke. Our aim was to explore whether LIF-transfected NSCs (LIF-NSCs) can ameliorate brain injury and promote neuroprotection in a rat model of cerebral ischemia. To accomplish this goal, we transfected NSCs with a lentivirus carrying the LIF gene to stably overexpress LIF. The LIF-NSCs reduced caspase 3 activation under conditions of oxygen-glucose deprivation in vitro. Transient cerebral ischemia was induced in rats by 2 h of middle cerebral artery occlusion (MCAo), and LIF-NSCs were intravenously injected at 6 h post-ischemia. LIF-NSC treatment reduced the infarction volume and improved neurological recovery. Moreover, LIF-NSCs improved glial cell regeneration and ameliorated white matter injury in the MCAo rats. The NSCs acted as carriers and increased the expression of LIF in the lesions to protect against cerebral infarction, suggesting that LIF-NSCs could be a potential treatment for cerebral infarction.

To study the effect of different storage time on the chemical compositions and sulfur dioxide residues of sulfur-fumigated Gastrodiae Rhizoma (GR), and provide scientific basis for solving the quality and safety issues of sulfur-fumigated traditional Chinese medicinal materials. GR, sulfur-fumigated GR and its medicinal slices were stored under the same conditions, and then 8 active ingredients and sulfur dioxide residues were measured respectively. The results showed that the content of gastrodins in sulfur-fumigated GR and its medicinal slices was significantly lower than that in the non-fumigated GR. Moreover, the content of sulfur dioxide residue in sulfur-fumigated GR was significantly higher than that in its medicinal slices. That is to say, sulfur fumigation degree had significantly higher effect on GR quality as compared with its medicinal slices. During the whole storage time (8 months), the content of the eight chemical components in GR was not changed greatly in general. However, after the storage for 4 months, the content of 8 components and sulfur dioxide residues in all of GR samples were significantly changed. In particular, the content of sulfur dioxide residue in GR medicinal materials decreased up to 50% or more.
Drug Storage ; Drugs, Chinese Herbal ; chemistry ; Fumigation ; Gastrodia ; chemistry ; Rhizome ; chemistry ; Sulfur ; Sulfur Dioxide ; analysis

As Gastrodiae Rhizoma (GR) is one of the herbs more seriously affected by sulfur fumigation, so its quality has been always of a great concern. In this paper, GR samples collected from eight main producing areas and in three forms were fumigated with sulfur and quantitatively and qualitatively analyzed based on UPLC-Q-TOF-MS/MS. The results showed that the contents of gastrodin, parishin, parishin B and parishin C were decreased, while the content of parishin E was increased after sulfur fumigation treatment. Besides, a new sulfur marker named p-hydroxybenzyl hydrogen sulfite was produced in sulfur-fumigated GR samples. As compared with producing origins, forms had a greater impact on the quality of GR, especially in Hongtianma and Wutianma. Besides, the contents of gastrodins and parishins in Hongtianma from Jilin were lowest as compared with those in other producing areas. This might be correlated with planting patterns and environmental factors. In conclusion, sulfur fumigation has a more obvious impact on the quality of GR than origins and forms, which is attributed to the generation of new sulfur fumigated markers.
Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; standards ; Fumigation ; Gastrodia ; chemistry ; Quality Control ; Rhizome ; chemistry ; Sulfur ; Tandem Mass Spectrometry

Studies on the characteristic chemical markers of sulfur fumigation have become an effective auxiliary way for quality control of traditional Chinese medicine. This study established a quantitative analysis method for the determination of -hydroxybenzyl hydrogen sulfite (-HS) in Gastrodiae Rhizoma (GR) based on UPLC-MS/MS. Then, 37 batches of GR were screened, and the results showed that 27 batches of them were sulfur-fumigated. Especially, the GR samples in Yunnan producing areas were sulfur-fumigated more seriously. Based on the stability of -HS after different storage time and heat treatment methods, it was found that the content of -HS was stable and reliable in the storage period of 8 months and under normal heat treatment (50, 60, 70, 80 °C) conditions. In conclusion, this study shows a high sensitivity, good selectivity and good stability of -HS, which can provide reference for the quality control and sulfur fumigation screening of GR.
China ; Chromatography, Liquid ; Drugs, Chinese Herbal ; chemistry ; standards ; Fumigation ; Gastrodia ; chemistry ; Quality Control ; Rhizome ; chemistry ; Sulfites ; analysis ; Sulfur ; Tandem Mass Spectrometry

The traditional sulfur fumigation processing method has been widely used in the initial processing and storage of traditional Chinese medicinal materials due to its economy, efficiency, convenience, high operability and effect on mold and insect prevention. However, excessive sulfur fumigation of traditional Chinese medicinal materials would lead to the changes in chemical compositions, and even endanger human health. This study showed that traditional Chinese medicinal materials were sulfur fumigated directly after being harvested for quick drying, or fumigated after being weted in the storage process for preventing mold and insects. We found that the sulfur dioxide limits for traditional Chinese medicinal materials were stricter than those for foods. Based on the existing limit standards, we obtained the data of sulfur dioxide residues for 35 types of traditional Chinese medicinal materials in a total of 862 batches. According to the limit standard in the Chinese Pharmacopoeia (150， 400 mg·kg⁻¹), the average over-standard rate of sulfur dioxide was as high as 52.43%, but it was reduced to 29.47% if calculated based on the limit for vegetable additive standard (500 mg·kg⁻¹). Sulfur fumigation issue shall be considered correctly: sulfur dioxide is a type of low toxic substance and less dangerous than aflatoxin and other highly toxic substances, and a small amount of residue would not increase the toxicity of traditional Chinese medicinal materials. However, sulfur fumigation might change the content of chemical substances and affect the quality of traditional Chinese medicinal materials. Furthermore, the exposure hazards of toxic substances are comprehensively correlated with exposure cycle, exposure frequency, and application method. In conclusion, it is suggested to strengthen the studies on the limit standard of traditional Chinese medicinal materials, formulate practical and feasible limit standard for sulfur dioxide residues in traditional Chinese medicinal materials that are consistent with the medication characteristics of traditional Chinese medicinal materials and can guarantee people's demand for safe medication.
Drugs, Chinese Herbal ; standards ; Fumigation ; Medicine, Chinese Traditional ; Sulfur ; Sulfur Dioxide ; standards

Objective To investigate the clinical efficacy of acupoint catgut embedding in treating breast cystic hyperplasia of blood stasis-phlegm pattern.Methods One hundred and three patients with breast cystic hyperplasia of blood stasis-phlegm pattern were randomly allocated to a treatment group of 53 cases and a control group of 50 cases. The treatment group received acupoint catgut embedding and the control group took Rupi Sanjie granules. The symptom/sign scores and the qi stagnation transformation score were recorded and sex hormone levels were measured in the two groups before and after 12 weeks of treatment. The clinical therapeutic effects were compared between the two groups.Results The cure rate and the total efficacy rate were 50.9% and 92.5%, respectively, in the treatment group and 46.0% and 90.0%, respectively, in the control group. There were no statistically significant differences in the cure rate and the total efficacy rate between the two groups (P>0.05). There were statistically significant post-treatment differences in the symptom/sign scores (pain, mass hardness, mass range, mass size and accompanying symptoms scores) between the two groups (P<0.05). At the three-month and six-month follow-ups, there were statistically significant differences in the pain, mass range and accompanying symptoms scores as compared with at the end of treatment in the treatment group, and between the treatment and control groups (P<0.05). There was a statistically significant pre-/post-treatment difference in the qi stagnation transformation score in the two groups (P<0.01,P<0.05). There was a statistically significant difference in the qi stagnation transformation score at the three-month and six-month follow-ups compared with at the end of treatment in the treatment group (P<0.05). There was a statistically significant difference in the qi stagnation transformation score between the treatment and control groups at the end of treatment and at the three-month and six-month follow-ups (P<0.05). There was a statistically significant pre-/post-treatment difference in the E2 content in the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in the P and PRL contents in the treatment groups (P<0.05).Conclusion Acupoint catgut embedding is an effective way to treat breast cystic hyperplasia of blood stasis-phlegm pattern.

Objective To summarize the medical rescue work of China emergency medical team in Philippines disaster area by typhoon Haiyan.Methods The rescue experience was summarized by retrospective study.Results A total of 1 831 patients visited the outpatient and emergency departments during those 10 days.According to the rapid risk assessment,the insect borne diseases,acute gastroenteritis infection and hospital infection were the major problems.The medical team took measures such as disinfection,vector control,cleaning up the environment,hospital infection control and providing the safe water to prevent the infectious diseases.Conclusion A sound organization and management system,high -quality members of the medical team,preparing the reasonable rescue plan and epidemic prevention measures,adequate supplies and effective communication were responsible for the success of the medical rescue.It is necessary to establish several international medical rescue teams at the national level.

Genetic studies are traditionally based on single-gene analysis. The use of these analyses can pose tremendous challenges for elucidating complicated genetic interplays involved in complex human diseases. Modern pathway-based analysis provides a technique, which allows a comprehen-sive understanding of the molecular mechanisms underlying complex diseases. Extensive studies uti-lizing the methods and applications for pathway-based analysis have significantly advanced our capacity to explore large-scale omics data, which has rapidly accumulated in biomedical fields. This article is a comprehensive review of the pathway-based analysis methods––the powerful methods with the potential to uncover the biological depths of the complex diseases. The general concepts and procedures for the pathway-based analysis methods are introduced and then, a comprehensive review of the major approaches for this analysis is presented. In addition, a list of available path-way-based analysis software and databases is provided. Finally, future directions and challenges for the methodological development and applications of pathway-based analysis techniques are dis-cussed. This review will provide a useful guide to dissect complex diseases.

Objective To explore the suicide intention and its influential factors among primary and junior high school students in rural areas of Anhui province,in order to provide evidence for early intervention related to mental health problems.Methods All students from 3 junior high and 5 primary schools in Changfeng county of Anhui were recruited as the study subjects using the cluster sampling method.Data were collected by using Children' s Depression Inventory,the Family APGAR Index,the Trait Coping Style Questionnaire,the Children' s Self-Esteem Scale,Social Anxiety Scale for Children,and the Quality of Life Scale.Chi-square test and Logistic regression were used to analyze the suicidal ideation and its influential factors respectively.Results 8.64％ (252/2917) of the studied children had suicidal ideation.Out of them,9.80％ (166/1694) and 7.03％ (86/1223) were left-behind or non-left-behind children.There was statistically significant difference on suicide ideation between the left-behind children and non-left-behind children (P=0.015).Data from the multivariate logistic regression analysis showed that social anxiety and negative coping style were the risk factors for suicidal ideation (P ＜0.05) while better family function and quality of life were the protective factors of suicidal ideation (P＜0.05).Conclusion Suicide ideation was relatively prevalent among rural children in Anhui province.Family,school and society should carry out different kinds of preventive measures to prevent suicide related behaviors in children from this area.