ObjectiveTo investigate the effects of artemisinin （ART） on histopathological damage and salivary secretion in the submandibular gland （SMG） of mice with Sjögren's syndrome （SS） model，and on the expression of aquaporin 5 （AQP5） in SMG cells. MethodsThe NOD/Ltj mice were used as a model of SS and randomly divided into the SS model group，the ART group，and the hydroxychloroquine sulfate （HCQ） group，with six mice per group. Another 6 female BALB/c mice at the same week were selected as the control group. Mice in the ART group was fed with the ART solution daily in the dosage of 50 mg·kg^-1，and mice in the HCQ group was given with the HCQ solution （1 300 mg·kg^-1）. Mice in the SS model and control groups were given saline daily. The treatment lasted for 8 weeks. The 24-hour average water intake，salivary flow rate，SMG pathology scores of mice in each group were measured，as well as the expression levels of AQP5 protein and gene in the SMG tissues. ResultsCompared with the control group，the 24-hour average water intake of mice in the model group was significantly increased （P<0.01），and the saliva flow rate was significantly decreased （P<0.01）. Compared to the SS model group，the 24-hour average water intake of mice in the ART and HCQ groups was significantly reduced （P<0.01），and the salivary flow rate was significantly increased in the ART group（P<0.01），comparisons between groups showed that the ART was superior to the HCQ in reducing water intake and improving saliva flow rate in SS model mice （P<0.05）. The HE staining results showed that，compared with the normal group，the number of lymphocyte infiltration foci in SMG tissue in the model group increased，and the pathological score increased （P<0.01）. Compared to the SS model group，after the intervention of the ART and HCQ，the number of lymphocytic infiltration foci in the SMG tissue decreased，the area of the lymphocytic infiltration foci was reduced，and the pathology score of the SMG tissues was lowered in the ART group（P<0.01）. However，there was no difference in pathological scores between the ART and HCQ groups . The results of IHC，Western blot，and Real-time PCR showed that，compared with the normal group，the expression levels of AQP5 protein and gene in SMG tissue in the model group significantly decreased （P<0.05）. Comparing with the SS model group，the ART and HCQ groups could significantly up-regulated the expression levels of AQP5 protein and mRNA in the SMG tissue，and the treatment effect was better than that of HCQ. ConclusionART was able to ameliorate SMG structural damage and salivary secretion function in SS model mice，and its mechanism of action may be related to the up-regulation of AQP5 protein and gene expression levels in SMG cells.

In this study,we aim to provide a comprehensive overview of the postoperative nursing care for patients undergoing radiofrequency catheter ablation in conjunction with minimally invasive left ventricular assist device implantation.The main nursing considerations include the following aspects.Regular assessment of the pulsation of bilateral lower limb arteries was conducted in order to maintain vigilance against the occurrence of deep vein thrombosis;the goal-oriented fluid management strategies were executed;it was crucial to focus on gastrointestinal responses and take steps to prevent gastrointestinal bleeding;the monitoring of chest indicators and respiratory function was enhanced to facilitate early detection of pneumothorax;the optimization of pain management was maximized.Following meticulous care and medical attention,the patient was transferred to the general ward on the 8th day post-surgery.On the 21st day after the procedure,the patient achieved full recovery and was subsequently discharged.

Objective To observe the correlation between apparent diffusion coefficient(ADC)of sacroiliac joint and spondyloarthritis research consortium of Canada(SPARCC)score in ankylosing spondylitis(AS)patients with different grade sacroiliac joint inflammation.Methods MR examinations of sacroiliac joint were prospectively performed in 35 AS patients(AS group)and 30 healthy controls(HC group).The grade of sacroiliac joint inflammation and SPARCC score in AS group were evaluated according to MRI findings,and the patients were then further divided into bone marrow oedema(BMO)subgroup(n=19)and non-BMO subgroup(n=16)according to whether BMO presented under articular surface or not,and ADC of sacroiliac joint(ADCsacroiliac)were measured.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to evaluate the efficacy of ADCsacroiliac for assessing AS sacroiliac joint inflammation grade.Pearson correlation analysis was performed to analyze the correlation between ADCsacroiliac and SPARCC score in AS patients with different grade sacroiliac joint inflammation.Results ADCsacroiliac in BMO subgroup and non-BMO subgroup was(4.85±1.44)×10-4 and(4.30±0.64)×10-4 mm2/s,respectively,being not significantly different(P＞0.05)but both higher than that in HC group([3.32±1.36]×10-4 mm2/s,both P＜0.05).The sensitivity of ADCsacroiliac for assessing grade of sacroiliac joint inflammation in AS patients was 49.44％,51.94％,73.06％and 60.50％,with specificity of 75.00％,78.92％,83.33％and 66.67％,respectively,and AUC of 0.613,0.712,0.837 and 0.645,respectively.ADCsacroiliac was moderately-highly positively correlated with SPARCC score of AS patients with Ⅱ and Ⅲgrade sacroiliac joint inflammation(r=0.580,0.933,both P＜0.05),but no obvious correlation was detected between ADCsacroiliac and SPARCC score of AS patients with Ⅰ or Ⅳ grade sacroiliac joint inflammation(both P＞0.05).Conclusion ADCsacroiliac was positively correlated with SPARCC scores of AS patients with Ⅱ and Ⅲ grade sacroiliac joint inflammation,which could be regarded as a reliable quantitative parameter for monitoring sacroiliac joint BMO.

Objective:To investigate the expression of Toll-like receptor 4(TLR4)and extracellular signal-regulated protein kinase 1/2(ERK1/2)in decidua tissue of patients with unexplained spontaneous abortion and their correlation.Methods:The expres-sions of TLR4,ERK1/2 and p-ERK1/2 in decidua tissues of 32 patients with unexplained spontaneous abortion(abortion group)and 32 normal pregnancy(control group)were detected by immunohistochemistry and Western blot,respectively.The correlation between TLR4 and p-ERK1/2 in abortion group were analyzed by Pearson hierarchical correlation analysis.Results:In immunohistochemical experiments,the cytoplasm of decidua cells in the two groups is the expression locus of TLR4,ERK1/2 and p-ERK1/2,the expression of the three proteins were different,and the expressions of TLR4 and p-ERK1/2 in abortion group were significantly higher than that in control group(P<0.01).There was no significant difference in ERK1/2 expression between abortion group and control group(P>0.05);In decidua tissue samples of abortion group,the protein level of TLR4 was higher than that of control group(P<0.05);the pro-tein level of p-ERK1/2 was significantly higher than that of control group(P<0.01),and the protein level of ERK1/2 in decidua tissue of abortion group was not statistically different from that of control group(P>0.05).TLR4 was positively correlated with p-ERK1/2 expression in abortion group(r=0.890,P<0.01).Conclusion:Abnormal activation of TLR4/ERK1/2 signaling pathway may be one of the mechanisms of unexplained spontaneous abortion.

Objective To explore the impact of prolonged sitting on lumbar disc degeneration using MRI T1ρ and T2 mapping.Methods A total of 25 taxi drivers(prolonged sitting group)and 24 age-matched non-prolonged sitting volunteers(control group)underwent routine lumbar MRI,T1ρ,and T2 mapping.The differences of T1ρ and T2 values for different Pfirrmann grades of anterior annulus fibrosus(AAF),nucleus pulposus(NP),and posterior annulus fibrosus(PAF)were analyzed using Variance analysis,Spearman correlation test,and receiver operating characteristic(ROC)curve was drawn,with independent t-tests was used for between-group com-parisons.Results Statistically significant differences were observed in T1ρ and T2 values for all Pfirrmann Ⅰ-Ⅱ grades NP and Pfirrmann Ⅱ-Ⅳgrades AAF,NP,and PAF in both groups(P＜0.05).Both T1ρ and T2 values were negatively correlated with Pfirrmann grades.The area under the curve(AUC)of T1ρ values for NP at each Pfirrmann grade were 0.928,0.987,and 0.968,respectively,while the AUC of T2 values for NP were 0.777,0.966,and 0.975,respectively.The T1ρ and T2 values of L4/L5 NP and L5/S1 AAF,NP,and PAF were lower in the prolonged sitting group compared to the control group(P＜0.05).Conclusion T1ρ is superior to T2 mapping in detecting lumbar disc degeneration.Prolonged sitting is more likely to cause degeneration of L4/L5 and L5/S1 inter-vertebral discs.

The typical manifestations of primary aldosteronism (PA) are hypertension with or without hypokalemia, high aldosterone, and low renal level. However, PA with normal blood pressure is rare in clinical practice. This article reported the diagnosis and treatment of a patient with subclinical PA, admitted for "adrenal accidental tumor" with normal blood pressure and serum potassium. We summarized and analyzed the clinical characteristics and treatment strategies, in order to provide some reference for clinicians.

Purpose: Mixed-lineage leukemia protein 4 (MLL4/KMT2D) is a histone methyltransferase, and its mutation has been reported to be associated with a poor prognosis in many cancers, including lung cancer. We investigated the function of MLL4 in lung carcinogenesis. Materials and Methods: RNA sequencing (RNA-seq) in A549 cells transfected with control siRNA or MLL4 siRNA was performed. Also, we used EdU incorporation assay, colony formation assays, growth curve analysis, transwell invasion assays, immunohistochemical staining, and in vivo bioluminescence assay to investigate the function of MLL4 in lung carcinogenesis. Results: We found that MLL4 expression was downregulated in non–small cell lung cancer (NSCLC) tissues compared to adjacent normal tissues and tended to decrease with disease stage progression. We analyzed the transcriptomes in control and MLL4- deficient cells using high-throughput RNA deep sequencing (RNA-seq) and identified a cohort of target genes, such as SOX2, ATF1, FOXP4, PIK3IP1, SIRT4, TENT5B, and LFNG, some of which are related to proliferation and metastasis. Our results showed that low expression of MLL4 promotes NSCLC cell proliferation and metastasis and is required for the maintenance of NSCLC stem cell properties. Conclusion Our findings identify an important role of MLL4 in lung carcinogenesis through transcriptional regulation of PIK3IP1, affecting the PI3K/AKT/SOX2 axis, and suggest that MLL4 could be a potential prognostic indicator and target for NSCLC therapy.

Objective:To assess the renal-protective effect of Elabela (Ela) on diabetic kidney disease (DKD), and explore its potential mechanism.Methods:db/db mice were randomly divided into diabetic group and Ela intervention group, while db/m mice were taken as normal control group. The mice in the Ela intervention group were intraperitoneally injected with Ela-21 5 mg·kg -1·d -1 for 8 weeks. At the end of the experiment, urinary albumin/creatinine ratio (UACR) was measured. The renal pathological changes were observed by HE and PAS staining. The expression of aquaporin 2(AQP2) examined by immunohistochemistry. The level of collage Ⅳ(Col-Ⅳ) and AQP2 in renal tissue was analyzed by Western blot. The human renal tubular epithelial cells (HK-2) were incubated with high glucose medium and further interfered with apelin receptors (APJ)-siRNA. Western blot analysis was used to detect the effect of Ela intervention on Col-Ⅳ and AQP2 expression. Finally, to clarify the possible mechanism of Ela regulating AQP2, the interaction between Ela-induced APJ activation and arginine vasopressin (AVP)-evoked arginine vasopressin receptor 2 (AVPR2) activation was investigated by NanoBit ? technology. Results:(1) Without affecting blood glucose and body weight, Ela intervention significantly reduced the UACR in db/db mice, and attenuate pathological changes of the kidney, as well as expression of Col-Ⅳ and AQP2. (2) Ela treatment could remarkably inhibit the high glucose-induced the expression of Col-Ⅳ and AQP2, which was reversed by interfering with APJ. (3) AVP-induced downstream β-Arrestin-2 signaling transduction via AVPR2 was obviously antagonized by interaction of Ela and APJ, further suggesting that the inhibitory effect of Ela on AQP2 may be related to antagonizing AVP/AVPR2 signaling.Conclusion:Ela exerts renal protection by inhibiting the expression of AQP2 through APJ.

INTRODUCTION: Inappropriate attendances (IAs) to emergency departments (ED) create an unnecessary strain on healthcare systems. With decreased ED attendance during the COVID-19 pandemic, this study postulates that there are less IAs compared to before the pandemic and identifies factors associated with IAs. METHODS: We performed a retrospective review of 29,267 patient presentations to a healthcare cluster in Singapore from 7 April 2020 to 1 June 2020, and 36,370 patients within a corresponding period in 2019. This time frame coincided with local COVID-19 lockdown measures. IAs were defined as patient presentations with no investigations required, with patients eventually discharged from the ED. IAs in the 2020 period during the pandemic were compared with 2019. Multivariable logistic regression was performed to identify factors associated with IAs. RESULTS: There was a decrease in daily IAs in 2020 compared to 2019 (9.91±3.06 versus 24.96±5.92, P<0.001). IAs were more likely with self-referrals (adjusted odds ratio [aOR] 1.58, 95% confidence interval [CI] 1.50-1.66) and walk-ins (aOR 4.96, 95% CI 4.59-5.36), and those diagnosed with non-specific headache (aOR 2.08, 95% CI 1.85-2.34), or non-specific low back pain (aOR 1.28, 95% CI 1.15-1.42). IAs were less likely in 2020 compared to 2019 (aOR 0.67, 95% CI 0.65-0.71) and older patients (aOR 0.79 each 10 years, 95% CI 0.78-0.80). CONCLUSION ED IAs decreased during COVID-19. The pandemic has provided a unique opportunity to examine factors associated with IAs.
COVID-19 ; Communicable Disease Control ; Emergency Service, Hospital ; Humans ; Pandemics ; Retrospective Studies ; SARS-CoV-2

Objective:To retrospectively analyze the clinical outcomes of single unrelated cord blood transplantation (UCBT) in children with high risk and refractory acute myeloid leukemia (AML) .Methods:Between June 2008 and December 2018, a total of 160 consecutive pediatric patients with AML received single UCBT (excluding acute promyelocytic leukemia) . Myeloablative conditioning (MAC) regimen were applied. All patients received a combination of cyclosporine A (CsA) and mycophenolate mofetil (MMF) for the prophylaxis of graft -versus- host disease (GVHD) .Results:The cumulative incidence of neutrophil cells engraftment at day +42 and platelet recovery at day +120 was 95.0% (95% CI 90.0%-97.5%) at a median of 16 days after transplantation (range, 11-38 days) and 85.5% (95% CI 83.3%-93.4%) with a median time to recovery of 35 days (range, 13-158) , respectively. Incidence of grades Ⅱ-Ⅳ and Ⅲ-Ⅳ acute GVHD and chronic GVHD were 37.3% (95%CI 29.3%-45.2%) , 27.3% (95% CI 20.0%-35.0%) and 22.4% (95% CI 15.5%-28.7%) , respectively. The transplant-related mortality (TRM) at 360 day was 13.1% (95% CI 8.4%-18.9%) . The 5-year cumulative incidence of relapse was 13.8% (95% CI 8.5%-20.3%) . The 5-year disease-free survival (DFS) and overall survival (OS) were 71.7% (95% CI 62.7%-77.8%) and 72.2% (95% CI 64.1%-78.7%) , respectively. The 5-year GVHD and relapse free survival (GRFS) was 56.1% (95% CI 46.1%-64.9%) . The 5-year cumulative recurrence rates of CR1, CR2, and NR groups were 5.3%, 19.9%, and 30.9% ( P=0.001) , and the 5-year OS rates were 79.9% (95% CI 70.3%-86.7%) , 71.1% (95% CI 50.4%-84.4%) and 52.9% (95% CI 33.0%-69.3%) ( χ2=7.552, P=0.020) , respectively. Conclusions:For pediatric patients with high risk and refractory AML, UCBT is a safe and effective treatment option, and it is favorable to improve the survival rate in CR1 stage.