Objective To investigate the main pharmacological basis and mechanism of action of Guhuaisi Kangfu Pill(GHSKF)in the treatment of steroid-induced osteonecrosis of the femoral head(SONFH).Methods The active constituents and targets of GHSKF were screened by using Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP)and other databases.The speculative targets of SONFH were screened out based on GeneCards and Online Mendelian Inheritance in Man(OMIM)databases.The gene modules and hub genes of SONFH were identified using a weighted gene co-expression network analysis(WGCNA).The intersection of the two targets and the result of WGCNA was taken to obtain the potential targets of GHSKF for the treatment of SONFH.The key active constituents were screened with the"active constituent-target"network,which was constructed by the Cytoscape software.Then,the STRING database was used to construct the protein interaction network to screen the key targets.The Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis of key targets was performed,and the relationship between key active constituent,key targets and key signaling pathways was explored.Finally,the molecular docking between key active constituents and key targets was verified.In addition,the SONFH rat model was used for experimental verification.Results A total of 146 compounds and the corresponding 346 targets were identified based on the TCMSP database.A total of 4 187 targets of SONFH were obtained based on GeneCards and OMIM databases.In addition,twelve gene modules and 2 556 hub genes of SONFH were screened out based on WGCNA.Quercetin,luteolin and kaempferol were key active ingredients for the treatment of SONFH.Various signaling pathways such as PI3K/AKT were involved.Molecular docking showed the key active ingredients had good binding activity with the key targets.The results of animal experiments demonstrated that GHSKF could improve bone biological alterations by up-regulating AKT1,PI3K,RUNX2,and down-regulating the expression of Caspase-3 and IL-6(P＜0.01),which verified some results of the network pharmacology prediction.Conclusion We analyzed the potential mechanism of action of GHSKF for the treatment of SONFH using network pharmacology and animal experiments,which may provide a reference for further research on its pharmacological basis and targets.

African swine fever virus(ASFV)I177L gene deletion vaccine is one of the key directions of African swine fever(ASF)live attenuated vaccine research and development.In order to effec-tively distinguish between the wild-type ASFV strain and the I177L gene-deleted strain,specific primers and probes were designed based on ASFV B646L and I177L genes,respectively.After screening and optimization,a duplex real-time PCR method was developed that can simultaneously detect these two genes.The results showed that ASFV B646L and I177L genes were detected spe-cifically and simultaneously by the method developed without cross-reactions with porcine circovir-us type 2,Seneca virus A,classical swine fever virus,foot-and-mouth disease virus,porcine respira-tory and reproductive syndrome virus.The detection limits of the duplex real-time PCR for recom-binant plasmids pUC57-B646L and pUC57-I177L were 1×103 copies/mL.The intra-and inter-as-say coefficients of variation were less than 4％,respectively.Detection of 122 pork and pork prod-ucts using the duplex real-time PCR developed and the real-time PCR recommended by WOAH showed that the coincidence rates of the two methods for B646L gene detection was 100％with two amplification curves appeared in the positive results of the established methods.The method established in this study can be used for the detection of ASFV I177L gene deletion strains,which provides technical support for ASF surveillance and epidemiological investigation.

Objective: To discuss the impact and practicability of pluralistic management when puerpera with hepatitis B virus (HBV) in hospital. Methods: By review researching and convenient sampling, two groups of puerpera with HBV were studied comparatively by the index of the time of breast milk, the breastfeeding rate and the satisfaction rate in hospital.The control group (411 cases, January to December, 2017) carried on the normal regulations nursing and the observation group (411 cases, January to October, 2018) carried on the pluralistic management in the Obstetrics and Gynecology Department of the Fifth Medical Center of PLA General Hospital. Results: The rate of the starting time of milk secretion (<24, 24-48, 49-72, >72 h) was 29.4%(121/411), 36.0%(148/411), 24.6%(101/411), 1.0%(41/411) in the observation group, and 13.6%(56/411), 21.7%(89/411), 33.3%(137/411), 31.4%(129/411) in the control group. The differences between the two groups were significant (χ² value was 7.66-57.43, all P<0.01). Postpartum hospital stay in 3 days and 6 days, the breastfeeding rate and average rate was 90.4%(198/219), 95.3%(183/192), 92.7%(381/411) in the observation group, and 79.0%(180/228), 84.2%(154/183), 81.3%(334/411) in the control group, the differences between the two groups were significant (χ² value was 11.13, 12.7, 23.61, all P<0.01). The total satisfaction rate in hospital was 99.5%(409/411) in the observation group, and 91.2%(375/411) in the control group, the difference between the two groups was significant (χ² value was 31.93, P<0.01). Conclusions Pluralistic management can raise the rate of breastfeeding of puerpera with HBV and the satisfaction of puerpera with HBV and her family.

Objective: To analyze the epidemiological characteristics of varicella epidemic situation at schools and kindergartens in Fengxian district of Shanghai during 2012-2018, and to provide evidence for developing control and prevention strategies. Methods: Data of varicella epidemic situation at schools and kindergartens and varicella cases were analyzed by descriptive methods. The rates were compared with chi-square test. Results: A total of 6 727 varicella cases were reported in Fengxian during 2012-2018, for an incidence of 85.34 per 100 000 population. Totally 66 varicella epidemic outbreaks and public health emergencies caused by varicella were reported, which involved 741 varicella cases. Among them, 426 were breakthrough cases (57.49%). The average interval time of breakthrough cases were (6.78±2.79)years, and the incidence was more concentrated in the 3-9 years after vaccination with varicella vaccine. Most breakthrough cases appeared 5 years past vaccination. The peak time of varicella was from April to June and from October to December. Most of cases were in the 5-11 year-old group and 15-17 year-old group. The cases in males was higher than in females. Kindergarten childcare and primary school children were at high risk of varicella. Timeliness of reporting was positively correlated with the duration of the varicella epidemic situation( r =0.52， P <0.05). Conclusion Most varicella epidemic situation in Fengxian district of Shanghai occued in primary schools during autumn and winter, and most of the varicella cases were breakthrough cases. Emergency vaccination of varicella vaccine can effectively control the spread of the epidemic. It is suggested to increase the publicity of the immunization program of 2 doses of varicella vaccine and raise the awareness of varicella vaccination of children’s parents.

In recent years, the clinical guidelines for the diagnosis and treatment of rheumatoid arthritis (RA) have been constantly updated. Among the general principles, it is particularly emphasized that, in order to improve the ratio of treat to target(T2T) of RA, doctors and patients should work together to negotiate the details of the guidelines. Therefore, it is important for patients to further understand the disease and clinical guidelines of RA, and to better cooperate with doctors. This study was based on the most concerned issues of RA patients and international standard procedure of guideline study, we organized the working group and introduce the following 16 recommendations constituting the RA patients′ practice guidelines.

OBJECTIVETo explore the appropriate operative strategy in recurrent groin hernia repair.

METHODSClinical and follow-up data of 82 patients with recurrent groin hernia undergoing operation at Department of Pancreatobiliary Surgery, Xiangya Hospital of Central South University from April 2010 to April 2017 were analyzed retrospectively. The operative approaches included laparoscopic transabdominal preperitoneal (TAPP) hernia repair, Lichtenstein repair and hybrid repair. Surgical method selection was based on the basis of European Hernia Society guidelines, combined with hernia histories, preoperative examination results and intra-operative results: (1) When an anterior approach (Lichtenstein, Bassini or Shouldice surgery) was adopted in the previous operation, TAPP was preferred for the recurrent groin hernia. (2) When the previous operation was an posterior approach [TAPP or total extraperitoneal hernioplasty (TEP)], Lichtenstein method was preferred. Moreover, Lichtenstein surgery with local anesthesia or nerve block was also selected when the patient could not tolerate general anesthesia. (3) When extensive preperitoneal adhesions were found in patients with previous anterior approach repair during laparoscopic exploration, especially in patients who had relapsed after multiple operations or had previous biochemical glues injection, hybrid surgery was preferred.

RESULTSAll 82 patients completed operations smoothly. TAPP, Lichtenstein and hybrid operation were applied in 74, 4 and 4 patients, respectively, with median operative time of 70 minutes (40-130 minutes) in TAPP, 60 minutes (40-90 minutes) in Lichtenstein and 120 minutes (70-150 minutes) in hybrid operation, respectively. The median numerical rating scales (NRS) score was 2 (0-6) on postoperative day 1. The incidences of postoperative seroma, pain and urinary retention were 4.9% (4/82), 2.4% (2/82) and 1.2% (1/82) respectively. The median postoperative hospital stay was 2 days (1-6 days). Seventy-two patients were followed-up from 11 to 87 months. The median follow-up period was 27 months. The median inguinal pain questionnaire (IPQ) score was 2 (0-8) month after operation. One recurrent case was reported 1 year after operation. No incision or mesh infection and long-term inguinal chronic pain were observed.

CONCLUSIONSFor recurrent patients with previous open anterior approach, TEP and TAPP repair are equivalent surgical techniques, and the choice should be tailored to the surgeon's expertise. For those with previous TAPP or TEP repair, Lichtenstein technique is recommended. For those with adhesions both in anterior transverse fascia and pre-peritoneum, hybrid operation may be the preferable choice according to adhesion conditions.

Groin ; Hernia, Inguinal ; surgery ; Herniorrhaphy ; Humans ; Laparoscopy ; Recurrence ; Retrospective Studies ; Surgical Mesh ; Treatment Outcome

Objective: To explore the influence of the location of the infarction lesion on the resting-state functional connectivity (rsFC) of the motor execution network. Methods: A total of 144 patients with infarction of the motor pathway were involved in the study, including 97 patients with capsule stroke (CS) and 47 patients with pontine stroke (PS).50 age-matched healthy subjects were enrolled.After acquiring the structural images and the resting-state functional MRI data of all the subjects by 3.0-Tesla MR scanner, the functional connectivity was calculated in different regions of interest and the differences of the rsFC within the motor execution network among patients with different infarction location were compared. Results: Left CS patients exhibited increased rsFC in L_PMd (MNI x, y, z: -22, -13, 57) -R_M1 (MNI x, y, z: 38, -22, 56) (F=3.951, P=0.022), the increased rsFC than healthy controls (P=0.031); Left CS patients exhibited increased rsFC in R_PMv (MNI x, y, z: 53, 0, 25)-L_SPL (MNI x, y, z: -22, -64, 54) than healthy controls (F=4.017, P=0.021), left CS patients exhibited decreased rsFC in R_PCG (MNI x, y, z: 37, -34, 53) -R_PMv (MNI x, y, z: 53, 0, 25) than healthy controls(F=-3.788, P=0.025). Right CS patients exhibited increased rsFC than healthy controls in R_PMd(MNI x, y, z: 28, -10, 54)-L_M1(MNI x, y, z: -38, -22, 56) (F=4.438, P=0.014), right CS patients exhibited increased rsFC than healthy controls in R_PMv(MNI x, y, z: 53, 0, 25)-R_PCG(MNI x, y, z: 37, -34, 53)(F=4.830, P=0.010), right CS patients exhibited decreased rsFC in L_M1(MNI x, y, z: -38, -22, 56)-L_SMA(MNI x, y, z: -5, -4, 57) than healthy controls (F=-5.102, P=0.007). And the left PS patients showed increased rsFC than healthy controls in R_DN -L_SMA (F=4.939, P=0.009), left PS patients exhibited increased rsFC than healthy controls in L_DN-R_SMA (F=3.431, P=0.036), left PS patients exhibited reduced rsFC than healthy controls in R_AICb -R_PMd (F=-4.114, P=0.019). Right PS patients showed increased rsFC compared with healthy controls in L_DN-R_M1(F=3.075, P=0.049), and increased rsFC compared with healthy controls in L_AICb-R_SCb (F=3.725, P=0.027). Conclusion The infarction location poses influence on the FC alteration of the motor network after stroke.

Objective To explore the characteristics of contrast-enhanced ultrasonagraphy(CEUS) of sarcomatoid hepatocellular carcinoma ( SHC ) . Methods Fifteen lesions identified pathologically from 15 patients were included in this study . Among them ,9 lesions had completely sarcomatoid change and 6 lesions had partially sarcomatoid change . Totally 8 lesions were in the small size group with maximum diameter＜ 50 mm and 7 lesions in the big size group with maximum diameter ≥ 50 mm . The CEUS performance was observed and analyzed . Results In the arterial phase of CEUS ,9 lesions in the group with completely sarcomatoid change showed rim hyperenhancement and 6 lesions in the group with partially sarcomatoid change showed whole hyperenhancement , the difference between the two groups was statistically significant ( P ＜ 0 .001 ) . However ,the difference of CEUS performance between small size group and big size group was not statistically significant ( P ＝ 0 .608 ) , all the lesions showed hypoechogenecity in portal and(or) late phase of CEUS . Conclusions The difference of performance on CEUS is not related to the size of SHC ,but to the degree of sarcomatoid change within the tumor . SHC with completely sarcomatoid change shows rim hyperenhancement and SHC with partially sarcomatoid change shows entire hyperenhancement in arterial phase on CEUS .

Objective To study the trends in surgical treatment and the outcomes of critical acute pancreatitis (CAP).Methods The clinical data of 76 patients with CAP who were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University from January 2010 to December 2017 were retrospectively reviewed.Data which included demographics,micro-organisms,surgical interventions and mortality were compared between the time periods of 2010 to 2013 and 2014 to 2017.Results Before 2014,19 patients with CAP were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital,Central South University.The percentage of multidrug resistant organisms (MDRO) in pancreatic drainage was 5.3％ (1/19).In the latter 4 years,57 patients with CAP were treated.The percentage of MDRO was 50.9％ (29/57),which was significandy higher than the initial 4 years (P＜0.001).For surgical treatment,the proportion of minimally invasive surgery in the latter 4 years was significantly higher than that in the initial 4 years.The percentage of percutaneous catheter drainage (PCD) increased from 63.2％ in the initial 4 years to 86.0％ in the latter 4 years.The proportion of minimal access retroperitoneal pancreatic necrosectomy (MARPN) increased from zero in the initial 4 years to 59.6％,while the proportion of open pancreatic necrosectomy (OPN) decreased from 68.4％ in the initial 4 years to 24.6％.The mortality rate of patients with CAP dropped from 52.6％ (10/19) in the initial 4 years to 24.6％ (14/57) in the latter four years.Conclusions In the center which specializes in treating pancreatitis,although the problem of bacterial resistance had become increasingly prominent,the mortality rate of CAP had shown a significant downward trend due to the development of various minimally invasive techniques.

We detected the isoniazid resistance in clinical Mycobacterium tuberculosis isolates by high-resolution melting (HRM) curve analysis and assessed the application value of the assay.The isoniazid resistance of 49 M.tuberculosis isolates preserved in laboratory was analyzed by the drug sensitivity test (traditional proportion method).Further analysis was made on the sequencing of the isoniazid resistance determining region in these test strains,and their mutation sites were screened.Specific primers used in the HRM curve analysis were designed based on the screened mutation sites,DNA mutations were assayed in the isoniazid-resistant gene determining region by the HRM curve analysis,and an assessment was made of the detection efficiency of the assay in isoniazid resistance in M.tuberculosis.Results of the drug sensitivity test (proportion method) showed that,of the 49 test strains,there were 20 isoniazid-resistant strains,29 isoniazid-sensitive strains.Results of the sequencing analysis showed that:1) KatG gene had four mutation patterns,i.e.,point mutations at site 234,at sites 234 and 315,at sites 234 and 463,and at sites 234,315 and 463;2) there were three mutations were detected in inhA gene,i.e.,mutations in inhA-8,-15 and-152.Analysis of gene mutation in drug-resistant strains found that of the 20 isoniazid-resistant strains,11 (55 ％) were mutated at codon 315 of KatG gene;6 (30％) were mutated in inhA-15 (4/20),-8 (1/20) and-153 (1/20) of inhA gene;two (10％) were mutated at codon 315 of KatG gene and in inhA-15;in one strain (5％),no mutation was detected in KatG and inhA genes.Through the gene mutation detection,the sensitivity and specificity of isoniazid resistance in M.tuberculosis were 95 ％ and 100 ％,respectively.Results of HRM curve analysis of drug-resistance gene mutations in test strains showed gene mutations were present in 18 strains and absent in 24 ones;referring to DNA sequencing results,the sensitivity and specificity of the assay were 94.7％ and 80％,respectively.Judged by mutations as drug-resistance via the HRM curve analysis,19 resistant and 24 sensitive strains were tested.With the drug sensitivity test results by the proportion method as controls,the sensitivity and specificity of the assay were 95 ％ and 82.76 ％,respectively.Use of the HRM curve in the detection of resistance of M.tuberculosis to isoniazid is characterized by good sensitivity and short time consuming,and has certain value in the rapid diagnosis of isoniazid-resistant tuberculosis.