Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.

ObjectiveTo investigate the potential mechanism of Xiao Chaihutang （XCHT） in the treatment of Alzheimer's disease （AD） based on network pharmacology and bioinformatics. MethodThe active components of XCHT and corresponding targets were retrieved from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）， and the differentially expressed genes related to AD were searched from Gene Expression Omnibus （GEO）. Thereby， the common targets of XCHT and AD were yielded， followed by Gene Ontology （GO） term enrichment and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis of the common targets. The component-target network and protein–protein interaction （PPI） network were constructed. Furthermore， amyloid β-protein （Aβ）_1-40 was used to induce AD in PC12 cells and then the AD cells were intervened with XCHT. Afterward， cell viability was detected by Cell Counting Kit-8 （CCK-8） assay and cell morphology was observed based on 4'，6-diamidino-2-phenylindole （DAPI） staining. Cell membrane potential was determined and apoptosis was detected by flow cytometry， and cellular immunofluorescence detects the expression of B-cell lymphoma-2 （Bcl-2）/Bcl-2-related X protein （Bax）. Moreover， immunofluorescence assay was performed. ResultA total of 190 active components and 41 anti-AD targets of XCHT were screened out. The key components included mairin， quercetin， berberine， protoporphyrin， 24-ethylcholest-4-en-3-one， and β-D-ribofuranoside， and the core targets were sigma non-opioid intracellular receptor 1 （SIGMAR1）， checkpoint kinase 1 （CHEK1）， protein tyrosine phosphatase non-receptor type 6 （PTPN6）， protein kinase C（PRKCH）， inhibitor of nuclear factor kappa B kinase subunit beta （IKBKB）， cathepsin D （CTSD）， cysteine aspartate protease-3 （Caspase-3）， Bax， and Bcl-2-like protein 1 （Bcl-2L1）. The anti-AD targets of XCHT were involved in 302 GO terms （P < 0.05）， particularly the regulation of neuronal cell apoptosis， and 73 KEGG pathways （P<0.05）. The major pathways and biological processes included the apoptosis pathway， virus infection pathway， lipid and atherosclerosis pathway， and cancer-related pathways. In the in vitro experiment， the model group demonstrated the decrease in cell survival rate （P<0.05）， increase in apoptosis rate （P<0.05）， and down-regulation of mitochondrial membrane potential and Bcl-2/Bax ratio compared with the blank control. Compared with the model group， XCFT group showed the increase in cell survival rate （P<0.05）， decrease in apoptosis rate （P<0.05）， and up-regulation of mitochondrial membrane potential and Bcl-2/Bax ratio. ConclusionBased on network pharmacology， this study reveals the multi-component， multi-target， and multi-pathway characteristics of XCHT in the treatment of AD， laying a foundation for further research on the material basis and mechanism of this prescription.

ObjectiveTo analyze the effects of Danggui Shaoyaosan （DSS） on the gut microbiota of the Alzheimer's disease （AD） model in SAMP8 mice based on 16S rDNA sequencing. MethodTwenty-four SAMP8 mice aged seven months were randomly divided into low-， medium-， and high-dose DSS groups （14.4， 28.8， 57.6 g·kg^-1·d^-1） and a model group according to a random number table， with six rats in each group. Six SAMR1 mice of the same age were assigned to the normal group. After intragastric administration for eight consecutive weeks， 16S rDNA sequencing was performed to detect the gut microbiota of feces in mice. Morris water maze was employed to assess the directional navigation and space exploration ability of mice. Nissl staining was performed to observe the pathological changes of neurons in the hippocampal CA1 area. Enzyme-linked immunosorbent assay （ELISA） was adopted to measure the protein content of hippocampal amyloid β-protein （Aβ） and hyperphosphorylated Tau （p-Tau）. ResultCompared with the normal group， the model group presented a declining α diversity （P<0.05）， markedly altered β diversity， prolonged escape latency （P<0.05）， reduced number of platform crossings and cumulative duration in the targeted quadrant （P<0.05）， decreased neurons and Nissl bodies in the CA1 hippocampal area， and up-regulated Aβ and p-Tau expression （P<0.05）. However， DSS intervention enhanced the α diversity， and medium- and high-dose DSS， especially the medium-dose DSS， could result in α diversity similar to the control group. Moreover， at the phylum level， the abundance of Firmicutes increased （P<0.05）， while the abundance of Bacteroidetes and Proteobacteria decreased （P<0.05）. At the genus level， the abundance of Lactobacillus and other genera increased （P<0.05）， while the abundance of Bacteroides， Helicobacterium， Rikenella， Parabacteroides， Sutterella， and Mucilaginibacter decreased （P<0.05）. The DSS groups also showed shortened escape latency （P<0.05）， increased number of platform crossings and cumulative duration in the targeted quadrant （P<0.05）， increased Nissl bodies （P<0.05）， and reduced Aβ and p-Tau content （P<0.05）. Pearson correlation analysis showed that the abundance of Mucilaginibacter， Bacteroides， and Sutterella was negatively correlated with the cognitive ability of SAMP8 mice， while the abundance of Lactobacillus and Butyricimonas was positively correlated with the cognitive ability of SAMP8 mice. ConclusionDSS can improve the cognitive ability of SAMP8 mice， and its mechanism may be related to the regulation of gut microbiota diversity and community composition.

OBJECTIVE: To evaluate the clinical features of preterm infants with a birth weight less than 1 500 g undergoing different intensities of resuscitation. METHODS: A retrospective analysis was performed for the preterm infants with a birth weight less than 1 500 g and a gestational age less than 32 weeks who were treated in the neonatal intensive care unit of 20 hospitals in Jiangsu, China from January 2018 to December 2019. According to the intensity of resuscitation in the delivery room, the infants were divided into three groups:non-tracheal intubation ( RESULTS: Compared with the non-tracheal intubation group, the tracheal intubation and ECPR groups had significantly lower rates of cesarean section and use of antenatal corticosteroid ( CONCLUSIONS For preterm infants with a birth weight less than 1 500 g, the higher intensity of resuscitation in the delivery room is related to lower rate of antenatal corticosteroid therapy, lower gestational age, and lower birth weight. The infants undergoing tracheal intubation or ECRP in the delivery room have an increased incidence rate of adverse clinical outcomes. This suggests that it is important to improve the quality of perinatal management and delivery room resuscitation to improve the prognosis of the infants.
Birth Weight ; Cesarean Section ; China ; Female ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Pregnancy ; Retrospective Studies

Objective: To evaluate the ability of new injury severity score (NISS), acute physiology and chronic health evaluation II (APACHE II), Glasgow coma scale (GCS), a combination of NISS and GCS, a combination of APACHE II and GCS, a combination of NISS and APACHE II to predict all-cause mortality of patients with severe trauma in mainland China. Methods: This was a multicenter observational cohort study conducted in the ICU of the Chonggang General Hospital, Daping Hospital of the Army Medical University and Affiliated Hospital of Zunyi Medical College from January 2012 to August 2016. The score of NISS, APACHE II, GCS, a combination of NISS and GCS, a combination of APACHE II and GCS, a combination of NISS and APACHE II were calculated based on data from the first 24 hours of ICU admission. Data were processed with Student's t-test, chi-square test, and receiver operating characteristic (ROC) curve of six scoring systems. Calibration was assessed with the Hosmer-Lemeshow test. The primary endpoint was death from any cause during ICU stay. Results: A total of 852 and 238 patients with severe trauma were assigned to the derivation group and validation group, respectively. Area under the ROC curve (AUC) was 0.826 [95% confidence interval (CI)=0.794-0.855)] for NISS, 0.802 (95% CI=0.768-0.832) for APACHE II, 0.808 (95% CI=0.774-0.838) for NGCS, 0.859 (95% CI=0.829 -0.886) for NISS+NGCS, 0.864 (95% CI=0.835-0.890) for APACHE II +NGCS, 0.896 (95% CI=0.869-0.929) for NISS+APACHE II in the derivation cohort. Similarly, the score of NISS+APACHE II was also better than the other five scores in the validation cohort (AUC=0.782; 95% CI=0.725-0.833) and had a good calibration (P=0.41). Conclusions: Taking into account anatomical and physiological parameters completely, the combination of NISS and APACHE II performs better than NISS, APACHE II, NGCS, NISS+NGCS, APACHE II +NGCS for predicting mortality in ICU severe trauma patients. It is needful to develop models that contain various types of accessible predictors (demographic variables, injury cause/mechanism, physiological and anatomical variables, etc.) as comprehensive as possible.

OBJECTIVE: To establish the STO cell lines expressing green fluorescent protein (GFP) and mouse leukemia inhibitory factor (LIF) , and try to culture the mouse embryonic stem cells (mESCs) by using the established STO-GFP-mLIF cells as the feeder layer. METHODS: The lentiviral particles containing GFP and mLIF and puromycin-resistance gene were constructed and transduced into STO cell lines. The cell lines stably expressing GFP and mLIF genes were screened out. The expression level of the inserted exogenous LIF gene was tested by Western blot and ELISA. The STO-GFP-mLIF cells were treated with different concentrations of mitomycin C (5, 10, 15, 20 µg/ml) for different time (1.5, 2.5, 3, 3.5 hours) to prepare feeder layers and the cell proliferation level on feeder layer was observed. Mouse embryonic stem cells were cultured on mitomycin C-treated feeder layer and the growth of cell colonies was observed. RESULTS: The expression level of LIF protein in STO-GFP-mLIF cells was up-regulated, as compared with STO cells (P＜0.05). It was confirmed that the optimal concentration and time for inhibiting the proliferetion of STO-GFP-mLIF cells by mitomycin C were 10 µg/ml and 3 hours respectively. The observation also found that the embryonic stem cells could develop into typic "birdnest" shaped stem cell colony on mitomycin C-treated feeder layer. CONCLUSION The stable STO cell lines effectively expressing green fluorescent protein and mouse leukemia inhibitory factor have been established successfully, which can maintain the undifferentiated state of mouse embryonic stem cells.
Animals ; Cell Differentiation ; Cell Line ; Cell Separation ; Embryonic Stem Cells ; Feeder Cells ; Green Fluorescent Proteins ; Leukemia Inhibitory Factor ; Mice

When troops are moving to high altitude areas above 3000 m,effective measures need to be taken to prevent the acute mountain sickness and to maintain soldiers' military operation abilities.This paper reviews the theories and applicability of high altitude acclimatization in recent years,involving training methods,medicine,nutrition and oxygen supply.Developments of medical support technologies for plateau missions by our army are also analyzed.

BACKGROUNDPlasma galectin-3, a mediator of fibrogenesis and inflammation, its potential to associate with type 2 diabetes (T2DM) is poorly investigated. Here, we explored its interaction with the serum galectin-3 and vascular complications.

METHODSWe conducted a population-based cross-sectional survey in Zhejiang, China involving 165 men and 119 women (age range, 43 - 84 years), investigating the relationship between serum galectin-3 and vascular disease in patients with T2DM.

RESULTSSerum galectin-3 was higher in subjects with T2DM than that in control participants (27.4 vs. 17.6 ng/ml, P < 0.001). Compared with subjects with galectin-3 values in the lowest quartile, those with values in the highest quartile had an increased likelihood of vascular complications (4th quartile odds ratio (OR) 2.52, 95% confidence interval (CI), 1.25 - 4.07). Increased risk of micro- or macrovascular complications correlated with serum galectin-3 concentration (ORs 11.4 and 8.5, respectively). An increased number of vascular complications was associated with high serum galectin-3 levels (P < 0.05). Patients with serum galectin-3 levels > 25 ng/ml had an elevated risk of diabetes relative to patients with levels < 10 ng/ml (OR for any vascular complication 2.64, for heart failure 3.97, for nephropathy 4.09, for peripheral arterial disease (PAD) 4.18; all P < 0.05). Complication risk was higher in patients with neurogenic, stroke, or retinopathy complications, but this difference was not significant after risk factor adjustment. Serum galectin-3 levels correlated with diabetes duration, C-reactive protein (CRP) levels, and albuminuria.

CONCLUSIONHigh galectin-3 values were associated with increased odds of developing heart failure, nephropathy, and peripheral arterial disease in patients with T2DM.

Adult ; Aged ; Aged, 80 and over ; C-Reactive Protein ; analysis ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Angiopathies ; blood ; etiology ; Female ; Galectin 3 ; blood ; Humans ; Male ; Middle Aged ; Risk Factors

OBJECTIVETo explore the exposure level and risk factors of heavy metal among Shanghai infants in their prenatal period.

METHODSA total of 1652 pregnant or puerperal women were recruited from 10 midwifery-qualified hospitals in Shanghai since October 2008 to October 2009, by the stratified cluster sampling method. They answered the questionnaire and their umbilical cord blood and serum were collected to detect the content of Pb, Hg, Mn, Cd, As and Tl. The risk factors were analyzed by single and multiple regression methods respectively.

RESULTSThe median value of the content of Pb, Hg, Mn, Cd, As and Tl were 41.00, 1.88, 4.10, 0.03, 0.86 and 0.02 µg/L respectively. The Hg concentration of pregnant women who ate fish for 4 - 7 times per week (9.7% (160/1652)) was 2.76 µg/L, which was higher than that of pregnant women who only ate fish for 1-3 times per week (49.3% (814/1652)) and those who seldom ate fish (40.0% (661/1652)); the Hg concentration in the two groups above were 2.41 and 2.03 µg/L separately. The difference had statistical significance (χ(2) = 36.40, P < 0.001). Meanwhile, the concentrations of Pb and Tl in the group of pregnant women whose houses were remodeled by PVC pipe (85.0% (1404/1652)) was higher than the concentrations in group of pregnant women whose houses were remodeled by galvanized pipe (15.0% (248/1652)); the Pb concentration in the two groups above were 45.54 and 40.00 µg/L (Z = 2.54, P < 0.05) and the Tl concentration in the two groups above were 0.021 and 0.018 µg/L (Z = 2.97, P < 0.05). However, the As concentration in the group of PVC pipe remodeled was 4.33 µg/L, which was lower than that in the group of galvanized pipe (9.37 µg/L). The difference had statistical significance (Z = 3.99, P < 0.01). The concentrations of Mn, Cd and Tl in the groups of pregnant women whose house had been remodeled in the last 3 years (38.0% (628/1652)) were 14.78, 0.51 and 0.022 µg/L separately, which were all significantly higher than those in the groups of women whose houses' were not remodeled (62.0% (1024/1652)), whose concentrations were 11.01, 0.29 and 0.02 µg/L respectively. The differences had statistical significance (Mn: Z = 2.46, P < 0.05; Cd: Z = 2.38, P < 0.05; Tl: Z = 2.81, P < 0.01).

CONCLUSIONThe infants in Shanghai were exposed to heavy metals in their prenatal period. The main sources of the exposure were daily diet and remodeled pollution.

Adult ; China ; Environmental Pollution ; Female ; Fetal Blood ; chemistry ; Humans ; Infant, Newborn ; Male ; Maternal Exposure ; adverse effects ; Metals, Heavy ; adverse effects ; Pregnancy ; Risk Factors ; Surveys and Questionnaires

BACKGROUNDSome studies found that cholinesterase (ChE) can be an independent risk factor for patients with multiple organ dysfunction syndrome. To assess aged patients with systemic inflammatory response syndrome (SIRS) early and predict their prognosis, the predictive value of ChE for the prognosis of aged patients with SIRS was analyzed.

METHODSFrom September 2009 to September 2010, all aged patients with SIRS in the ICU of the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed if they met inclusion criteria: patients aged ≥ 65 years and met American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference criteria for SIRS. Serum ChE, albumin, D-dimer, lactic acid and C-reactive protein (CRP) were measured, and the Acute Physiology and Chronic Health Evaluation (APACHE) II and Glasgow Coma Scale (GCS) scores were evaluated within the first 24 hours in the ICU. Fisher's exact test was used for comparison of the primary disease between the deceased group and surviving group. For comparison of study variables between the two groups, the Student's t test or Mann-Whitney U test was used. Multivariate significance was tested with binary Logistic regression analysis.

RESULTSThe clinical data of 124 aged patients with SIRS were collected and analyzed. Sixty-six patients (46 male, 20 female, mean age (78.70 ± 8.08) years) who died were included in the deceased group and 58 patients (34 male, 24 female, mean age (76.02 ± 6.57) years) who survived were included in the surviving group. There were no significant differences in age, gender, APACHE II score and GCS score between the deceased group and surviving group (all P > 0.05), but there were significant differences in lactic acid (P = 0.011), D-dimer (P = 0.011), albumin (P = 0.007), CRP (P = 0.008), and ChE (P < 0.0001). The correlation analysis showed that the APACHE II score and CRP were not correlated with ChE (both P < 0.05). D-dimer and albumin were correlated with ChE (Spearman's rho correlation coefficients were -0.206 and 0.324, the corresponding P values were 0.022 and < 0.0001). Multiple Logistic regression analysis showed that age, gender, lactic acid, D-dimer, albumin, CRP, APACHE II score, and GCS score were not independent risk factors for prognosis of aged patients with SIRS, but that ChE was (P < 0.0001). The receiver operating characteristic curve of ChE had an area under the curve of 0.797 (standard error = 0.04; P < 0.0001), and a ChE of 103.00 U/L was the cut-off value with sensitivity = 0.793, specificity = 0.742.

CONCLUSIONSerum ChE might be a predictive marker for the prognosis of aged patients with SIRS, with low serum ChE levels indicating poor prognosis.

Aged ; Aged, 80 and over ; Cholinesterases ; blood ; Female ; Humans ; Male ; Prognosis ; Systemic Inflammatory Response Syndrome ; blood ; enzymology ; pathology