BACKGROUND:Perinatal hypoxic-ischemic brain injury is one of the most common causes of cerebral palsy.Shujin Jiannao Prescription is an experienced formula for treating cerebral palsy and improving blood supply to the brain developed by the Dongzhimen Hospital,Beijing University of Chinese Medicine. OBJECTIVE:To explore the possible mechanism of Shujin Jiannao Prescription in treating hypoxic-ischemic cerebral palsy. METHODS:Sixty-four 7-day-old Sprague-Dawley rats were randomly divided into six groups.There were 12 rats in each of the control and model groups as well as 10 animals in each of the minocycline group,and the low-,medium-,and high-dose groups of Shujin Jiannao Prescription.The neonatal rat ischemic-hypoxic cerebral palsy model was established in all groups except for the control group.After successful modeling,rats in each drug group were respectively gavaged with minocycline and Shujin Jiannao Prescription at a dose of 4,8,and 16 g/kg per day for 1 week.Body mass of rats was measured and behavioral changes were detected before and after drug administration.Hematoxylin-eosin staining was used to observe the histomorphology of hippocampal CA1 region of rat brain tissue,and immunohistochemistry and western blot were used to detect the expression levels of Bcl-2,Bax,and Caspase-3 in the brain tissue of rats. RESULTS AND CONCLUSION:Compared with the model group,medium-and high-dose Shujin Jiannao Prescription significantly increased the body mass of rats(P<0.05).Compared with the model group,minocycline effectively prolonged the suspension time of ischemic-hypoxic cerebral palsy rats(P<0.05),while medium-and high-dose Shujin Jiannao Prescription significantly prolonged the suspension time,shortened the inclined plane test time,and increased the Longa score of rats(P<0.05).The pathological results showed that after drug intervention,only a small number of neuronal cells in the brain tissue of rats were necrotic,the cells were more neatly arranged,the cell structure was more complete,and only part of the cell nuclei became smaller.Compared with the model group,minocycline and medium-and high-dose Shujin Jiannao Prescription reduced the expression of Bax Caspase-3(P<0.05),medium-and high-dose Shujin Jiannao Prescription increased the expression of Bcl-2(P<0.05),and Bcl-2/Bax protein expression was increased in minocycline and three Shujin Jiannao Prescription groups(P<0.05).In addition,the protein expression was increased in a dose-dependent manner after intervention with Shujin Jiannao Prescription,and there was no significant difference between the minocycline and three Shujin Jiannao Prescription groups(P>0.05).To conclude,the mechanism by which Shujin Jiannao Prescription treats ischemic-hypoxic cerebral palsy in rats may be to enhance the expression of anti-apoptotic protein Bcl-2,inhibit the expression of pro-apoptotic protein Bax,and reduce the expression of Caspase-3,ultimately inhibiting the apoptosis of hippocampal neuronal cells in rats with cerebral palsy.Within a certain range,the higher dose of Shujin Jiannao Prescription indicates the better therapeutic effect,and the high-dose Shujin Jiannao Prescription is as effective as minocycline.

Objective To investigate the differences in efficacy and safety in the treatment of patients with cerebral palsy at different grades of the Gross Motor Function Classification System (GMFCS) by selective posterior rhizotomy (SPR). Methods Relevant literatures on SPR treatment for cerebral palsy were retrieved from Pubmed, Embase, Web of Science, China Biology Medicine disc, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database. Clinical trials on SPR treatment for cerebral palsy were included for Meta-analysis. At least two researchers independently screened the literatures, extracted data, and assessed the quality of the literatures. Data analysis was performed by Review Manager 5.4 software. Results A total of 2, 726 literatures were retrieved, and 8 literatures were finally included after screening. The results of the Meta-analysis showed that the gross motor function and self-care ability of patients with cerebral palsy at all GMFCS grades improved significantly after surgery, and muscle tone decreased significantly after surgery (P < 0.05). In comparison of the improvement in gross motor function before and after SPR, patients with grades Ⅱ and Ⅲ of GMFCS benefited the most, followed by those with grade Ⅰ, and those with grades Ⅳ and V benefited less. In terms of improving self-care ability, patients with grade Ⅰ benefited the most, followed by those with grade Ⅲ, and those with grades Ⅱ and IV benefited less. No significant adverse reactions were reported in previous literatures. Conclusion SPR is a relatively safe and effective treatment option for patients with cerebral palsy. Patients at grades Ⅱ and Ⅲ of GMFCS benefit the most from SPR, and patients at grades Ⅳ and V with poor preoperative physical status can also benefit from SPR.

ObjectiveTo explore the mechanism of Tangbikang granules （TBK） against diabetic peripheral neuropathy （DPN） based on network pharmacology and in-vivo experiment. MethodThe active components in medicinals of TBK and their target genes were searched from Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform （TCMSP）. The active components of the medicinals which are not included in TCMSP were searched from previous research. After the analysis of drug-likeness by SwissADME， the target genes of them were predicted with SwissTargetPrediction. DPN-related target genes were retrieved from GeneCards. The common targets of the disease and the prescription were the hub genes of TBK against DPN， which were uploaded to Metascape for Gene Ontology （GO） term enrichment and Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway enrichment analysis. High-sugar and high-fat diet and low-dose streptozotocin （STZ， ip） were employed to induce diabetes in rats， and then the model rats were respectively treated with low-dose （0.625 g·kg^-1）， medium-dose （1.25 g·kg^-1）， and high-dose （2.5 g·kg^-1） TBK for 12 weeks. Sensory nerve conduction velocity （SNCV） was evaluated. After hematoxylin and eosin （HE） staining， the sciatic nerve was observed under light microscope to examine the nerve damage. Real-time PCR was performed to detect the gene expression of adenosine monophosphate-activated protein kinase （AMPK） pathway-related targets in rat sciatic nerve， and Western blot to measure the protein expression of AMPK and phosphorylated （p）-AMPK in rat sciatic nerve. ResultThe main active components of TBK， such as quercetin， kaempferol， β-sitosterol， leech pteridine A， stigmasterol， and baicalein were screened out， mainly acting on interleukin-6 （IL-6）， tumor necrosis factor （TNF）， protein kinase B （Akt）， JUN， and HSP90AA1 and signaling pathways such as AMPK， nuclear factor-κB （NF-κB）， and Janus kinase/signal transducer and activator of transcription （JAK/STAT）. Molecular docking results showed that β-sitosterol and stigmasterol had high binding affinity with IL-6， TNF， JUN， and HSP90AA1. As for the animal experiment， compared with the normal group， model group had low SNCV of sciatic nerve （P<0.01）， disordered and loose myelinated nerve fibers with axonotmesis and demyelinization， low mRNA expression of AMPKα， AMPKβ， peroxisome proliferator-activated receptor γ coactivator-1α （PGC-1α）， Sirtuin 3 （SirT3）， mitochondrial transcription factor A （TFAM）， and low p-AMPK/AMPK ratio in sciatic nerve （P<0.05， P<0.01）. Compared with the model group， TBK of the three doses raised the SNCV （P<0.01）， restored nerve morphology and nerve compactness， and increased the mRNA expression of AMPKα， AMPKβ， PGC-1α， SirT3， and TFAM （P<0.05， P<0.01）. The ratio of p-AMPK/AMPK in the high-dose and medium-dose TBK groups was higher than that in the model group （P<0.01）， while the protein expression in the low-dose TBK group was insignificantly different from that in the model group. ConclusionTBK exerts therapeutic effect on DPN through multiple pathways and targets. The mechanism is that it activates and regulates AMPK/PGC-1α/SirT3 signaling， which lays a basis for further study of TBK in the treatment of DPN.

【Objective】 To detect the piperacillin and amoxicillin antibodies in suspicious blood samples from pre-transfusion compatibility tests in Wuxi and analyze the general characteristics of them, so as to eliminate the interference of drug-induced antibodies with compatibility tests and provide reference for safe and effective blood transfusion, 【Methods】 Drug-sensitized RBCs and low-ion anti-globulin microcolumn gels were used to detect piperacillin and amoxicillin antibodies in 128 plasma samples which were initially undetermined in pre-transfusion compatibility tests. Data were analyzed by Chi-square test or fisher′s exact test. P<0.05 was statistically significant. 【Results】 Among these 128 undetermined samples, including 31 cases of type A, 48 type B, 14 type AB and 35 type O, the overall positive rate of piperacillin and amoxicillin antibodies was 28.9%(37/128), in which the positive rates of piperacillin and amoxicillin antibodies were 20.3%(26/128) and 8.6%(11/128), respectively. The difference between these two drug-induced antibodies was significant(P<0.05). Further analysis showed that the piperacillin antibodies in patients over 50 years old was 25.3%(24/95), while under 50 years old was 6.1%(2/33)(P<0.05). In contrast, the amoxicillin antibodies in patients over 50 years old was 5.3%(5/95), while under 50 years old was 18.2%(6/33), with statistically significant differences between each other(P<0.05). 【Conclusions】 In patients with suspicious antibodies in pre-transfusion detection, except for the allotype antibodies, drug-induced antibodies should be more considered in combination with medication history to better ensure the safety and effectiveness of blood transfusion.

Objective:To estimate in-hospital mortality after knee replacement (KR) and to assess its trend and risk factors in China.Methods:We included patients undergoing KR in the Hospital Quality Monitoring System in China (2013-2019) to estimate in-hospital mortality after KR and assessed relation of patient's and hospital's characteristics (year of surgery, age, gender, marital status, primary indication, Charlson comorbidity index, geographic location, hospital type, hospital volume of KR, and surgery type) to in-hospital mortality using multivariable Poisson regression.Results:The annual amount of KR has increased from 20 307 in 2013 to 35 757 in 2019, and has maintained an upward trend for 7 years. The mean age of patients having KR increased from 64.9 years in 2013 to 66.6 years in 2019. Of the total 218 923 KRs, 63 deaths (0.29‰) occurred within 30 days before discharging. Older age was associated with higher in-hospital mortality ( P for trend <0.001). Male gender had higher incidence of in-hospital mortality compared with female [relative risk (RR), 2.5; 95% CI: 1.5, 4.1]. Single marital status was associated with higher, albeit non-statistically significant, in-hospital mortality than married patients (RR, 2.1; 95% CI: 0.9, 4.6). Higher Charlson comorbidity index was associated with increased risk of in-hospital mortality ( P for trend <0.001). Risk of in-hospital mortality decreased with more hospital-year knee replacement surgeries ( P for trend <0.001). In-hospital mortality varied by geographic regions, with the lowest mortality in East region (0.16‰), followed by South-West (0.31‰), South-Central (0.31‰), North region (0.33‰), North-West (0.54‰) and North-East (0.59‰). Conclusion:In-hospital mortality after KR in China was relatively low. Older age, male gender, higher Charlson comorbidity index and lower hospital-year knee replacement surgeries were risk factors for in-hospital mortality. The mortality varied greatly according to the geographic location of hospital.

Background According to China's Labor Statistics Yearbook 2020, there were 113293 work-related injuries and 25092 work-related deaths in 2019. It is of great significance to enhance the courage quality of high-risk workers for the maintenance of personal health and the effectiveness of organizational work. Objective To revise the Physical Courage at Work Scale (PCWS) for its application in Chinese employees exposed to high-risk workplace. Methods A total of 1280 high-risk workers completed the revised PCWS for Chinese employees. Item analysis and exploratory factor analysis were used to analyze the scale's construction validity. Confirmatory factor analysis was used to verify the results of exploratory factor analysis, Cronbach's α coefficient was used to verify the reliability of the scale, Pearson correlation analysis of the scale with Mental Quality Questionnaire for Armymen (MQQA) and Norton Courage Measure (CM) was used to verify the validity of the revised PCWS, and Pearson correlation analysis was used to determine the discrimination for each factor of the revised PCWS. Results The results of item analysis showed that the correlation coefficients between the scores of all items and the total score of the revised PCWS were greater than 0.4. The exploratory analysis indicated that there were five factors including immediate danger,providing for family, confronting other's aggression, reporting violations, and contributing to society in the revised version. The confirmatory analysis indicated the five-factor model fitted well (minimum fit function Chi-square/degree of freedom, CMIN/DF=4.60; normed fit index, NFI=0.93; comparative fit index, CFI=0.95; incremental fit index, IFI=0.93; standardized root mean square residual, SRMR=0.05; root mean square error of approximation, RMSEA=0.07). The internal consistency coefficient of the revised PCWS was α=0.95. The correlation coefficients of the revised PCWS with MQQA and CM ranged from 0.11 to 0.28 (P<0.01), and the correlation coefficients between factors of the revised scale ranged from 0.35 to 0.72 (P<0.01). Conclusion The revised PCWS has good reliability and validity in Chinese employees.

OBJECTIVETo summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.

METHODSClinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.

RESULTSAmong 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.

CONCLUSIONSThe choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.

OBJECTIVETo investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor(GIST) after surgery in Shandong Province.

METHODSClinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analyses with Log-rank test and Cox proportional hazard model.

RESULTSA total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years(median, 58). Ninety-three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection(88.8% vs 69.0%, P<0.05). For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups(P>0.05). For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively(P<0.05). Multivariate analysis revealed that tumor size(P<0.01, RR=1.988, 95%CI:1.497-2.641), mitotic count(P<0.01, RR=2.326, 95%CI:1.686-3.208) and tumor rupture(P<0.01, RR=3.032, 95%CI:1.732-5.308) were independent prognostic factors.

CONCLUSIONSTumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of localized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Benzamides ; Cohort Studies ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Gastrointestinal Neoplasms ; diagnosis ; therapy ; Gastrointestinal Stromal Tumors ; diagnosis ; therapy ; Humans ; Imatinib Mesylate ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Piperazines ; Prognosis ; Proportional Hazards Models ; Pyrimidines ; Retrospective Studies ; Survival Rate ; Young Adult

Objective To investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor (GIST) after surgery in Shandong Province. Methods Clinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analys es with Log-rank test and Cox proportional hazard model. Results A total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years (median, 58). Ninety-three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection (88.8% vs 69.0%, P<0.05). For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups (P>0.05). For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively (P<0.05). Multivariate analysis revealed that tumor size (P<0.01, RR=1.988, 95%CI:1.497-2.641), mitotic count (P<0.01,RR=2.326, 95%CI:1.686-3.208) and tumor rupture (P<0.01, RR=3.032, 95%CI:1.732-5.308) were independent prognostic factors. Conclusions Tumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of localized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.

Objective To investigate the clinicopathological features and prognosis of patients with gastrointestinal stromal tumor (GIST) after surgery in Shandong Province. Methods Clinicopathological data of GIST patients undergoing surgery from January 2001 to June 2013 in four university teaching hospitals in Shandong Province were reviewed. Pathology results were rechecked. Patients were followed up. The prognostic factors were evaluated by univariate and multivariate analys es with Log-rank test and Cox proportional hazard model. Results A total of 1039 GIST cases were enrolled, including 509 males and 530 females, with age from 18 to 87 years (median, 58). Ninety-three patients died of GIST during follow-up. The 1-, 3-, 5-year survival rates were 94.6%, 91.7% and 87.8%, respectively. Patients undergoing R0 resection had a higher 5-year overall survival rate than those undergoing R1 resection (88.8% vs 69.0%, P<0.05). For patients with intermediate risk of recurrence after surgery, the 5-year overall survival rate was 94.4% and 89.2% respectively in imatinib and non-imatinib intervention groups (P>0.05). For patients with high risk of recurrence after surgery, the 5-year overall survival rate was 76.8% and 67.7% respectively (P<0.05). Multivariate analysis revealed that tumor size (P<0.01, RR=1.988, 95%CI:1.497-2.641), mitotic count (P<0.01,RR=2.326, 95%CI:1.686-3.208) and tumor rupture (P<0.01, RR=3.032, 95%CI:1.732-5.308) were independent prognostic factors. Conclusions Tumor size, mitotic count and tumor rupture affect the prognosis of patients after resection of primary GIST independently. The standard treatment of localized GIST is R0 resection. Adjuvant imatinib therapy can improve overall survival of patients with high risk of recurrence after surgery. The efficacy of imatinib for patients with intermediate risk of recurrence remains to be verified.