Atrial functional mitral regurgitation (AFMR) is mitral regurgitation in patients with atrial fibrillation (AF), whose left atrium (LA) is enlarged, the left ventricle is not enlarged or only slightly enlarged, the left ventricular ejection fraction is preserved, and the mitral valve itself has no apparent lesion. At present, the etiology, pathophysiology and mechanism of this disease have not been completely clear yet. Existing studies have found that the causes of AFMR mainly include AF, enlargement of LA and mitral annulus, destruction of mitral annular shape, inability of mitral valve remodeling to compensate for mitral annular expansion, and hamstringing of the posterior mitral leaflet by atriogenic tethering. AFMR is demonstrated to be associated with an increased risk of mortality and readmission due to heart failure. Therefore, it serves as a primary therapeutic target for patients with heart failure and AF. However, the optimal treatment of AFMR still remains controversial. Therefore, this article will mainly expound the current definition, etiology, pathophysiological mechanism, treatment, and prognosis of AFMR.

OBJECTIVE To establish a rapid method for determining of acid yellow 36 in moxibustion. METHODS Based on the principle of acid yellow 36 as an acid-base indicator and discoloration in the pH range of 1.2(red) to 2.3(yellow), 15% sulfuric acid solution was used as the color developing agent to screen the ethanol extract of the sample, and then HPLC method was used to verify the suspicious positive samples in the initial screening, and finally LC-MS method was used to confirm the accuracy of the established rapid physicochemical detection method. RESULTS The established method was applied to 67 batches of samples, and 3 positive samples were detected. The results were consistent with those of HPLC and LC-MS. CONCLUSION The method is accurate and sensitive, which can be used for rapid detection of acid yellow 36 in moxibustion.

[摘 要] 目的：探讨低剂量辐射（LDR）与人端粒酶逆转录酶C末端多肽27（hTERTC27）过表达联合治疗对肺癌A549细胞增殖和凋亡的影响，同时观察LDR与常规放疗（CONV-RT）结合的体内抑瘤效应。方法：将pEgr-hTERTC27质粒转染人非小细胞肺癌A549及小鼠LLC肺癌（LLC）细胞，用G418筛选建立稳定表达C27的A549-C27细胞和LLC-C27细胞。细胞实验分为6组，分别是CONV-RT（A549-Con）、低剂量照射（A549-Low）、C27（A549-C27）、常规剂量联合C27（A549-C27-Con）、低剂量照射联合C27（A549-C27-Low）和对照（A549-Mock）组，其中Low组的辐照剂量仅为Con组的36%。MTT法检测各组细胞增殖活性，流式细胞术检测各组细胞凋亡率。通过皮下种植建立LLC肺癌移植瘤小鼠模型，动物实验分组同细胞实验；记录各组小鼠肿瘤生长情况，并检测各组肿瘤体积和质量，H-E染色观察各组移植瘤组织邻近肌肉浸润情况。结果：与A549-Mock比较，A549-Con和A549-Low组细胞增殖活性均显著降低（均P < 0.01）；而且A549-C27-Con和A549-C27-Low组细胞增殖活性显著低于A549-C27组（均P < 0.01）。与A549-Mock组比较，A549-Con组和A549-Low组细胞凋亡率均显著升高（均P < 0.01）；A549-C27、A549-C27-Con和A549-C27-Low组细胞凋亡率无显著差异（P > 0.05）。与未经照射治疗的荷瘤小鼠相比较，CONV-RT及LDR + CONV-RT均可使荷瘤小鼠肿瘤质量显著降低（均P < 0.01）。此外，LDR + CONV-RT + C27组肿瘤质量显著减小，局部浸润减少（均P < 0.01）。结论：LDR与CONV-RT相结合能够在降低辐射总剂量的同时达到与CONV-RT单独使用相似的非小细胞肺癌肿瘤抑制效果。而且，LDR与C27多肽有协同抗肿瘤作用，两者同时使用能够使移植瘤局部浸润减少。

Objective     To investigate the risk factors for postoperative complications Clavien-Dindo classification≥grade Ⅱ after lung cancer surgery. Methods     The patients who underwent lung cancer surgery in a multicenter observational study from November 2017 to January 2020 were included. The Clavien-Dindo classification of postoperative complications was analyzed. Logistic regression was used to identify the risk factors for complications≥ gradeⅡ. Results     A total of 388 patients were enrolled, including 203 males and 185 females with a mean age of 56.14±10.36 years. The incidence of postoperative complications was 25.52% (99/388) after lung cancer surgery and the incidence of complications≥gradeⅡ was 20.10% (78/388). The five most common postoperative complications were pneumonia (6.96%), prolonged pulmonary air leak (>7 days, 5.67%), incision dehiscence (4.64%), arrhythmia (3.87%), and postoperative pleural effusion (3.35%). Multivariate analysis showed that open surgery [reference: uniportal thoracoscopic surgery, OR=2.18, 95%CI (1.01, 4.70), P=0.047], extended resection [reference: sublobar resection, OR=2.86, 95%CI (1.11, 7.19), P=0.030; reference: lobectomy, OR=2.20, 95%CI (1.10, 4.40), P=0.026] and operative time≥3 h [OR=2.07, 95%CI (1.12, 3.85), P=0.021] were independent risk factors for postoperative complications≥gradeⅡ after lung cancer surgery. Conclusion     Surgical approach, extent of resection and operative time are independent influencing factors for postoperative complications≥gradeⅡ after lung cancer surgery.

Objective    To investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma. Methods    The clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People&#39;s Hospital from August 2019 to October 2020 were retrospectively analyzed. According to the different treatments, the patients were divided into two groups: a neoadjuvant immunotherapy combined with chemotherapy group (NIC group) and a neoadjuvant chemoradiotherapy group (NC group). The baseline data, incidence of adverse events during treatment, perioperative indicators, postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups. Results    Totally 33 patients were enrolled, including 15 males and 18 females, with an average age of 62.37±7.99 years. There were 17 patients in the NIC group and 16 patients in the NC group. In the NIC group, the carcinoma was mainly located in the middle and lower esophagus, with 5 paitents in stage Ⅱ, 9 patients in stage Ⅲ, and 3 patients in stage Ⅳa. In the NC group, the carcinoma was mainly located in the upper-middle esophagus, with 1 patient in stage Ⅱ and 15 patients in stage Ⅲ. During the neoadjuvant treatment, there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups (P>0.05). There were 4 immune-related rashes in the NIC group and 1 esophageal perforation in the NC group. Fourteen (82.35%) patients in the NIC group and 12 (75.00%) patients in the NC group completed the operation on schedule. The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group (P<0.05). There were 5 patients of complete remission in the NIC group, and 6 patients in the NC group. There was no significant difference in the pathological regression grade or residual tumor cells between the two groups (P>0.05). There was no significant difference in the incidence of anastomotic fistula, thoracic gastric fistula, bronchial mediastinal fistula, abdominal distension, pulmonary infection, stroke, or hoarseness during the perioperative period between the two groups of patients who completed the operation (P>0.05). In the NC group, 2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection. Conclusion    Neoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission, which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe, feasible and potential new treatment model.

Objective: To explore the protective effects of anthrahydroquinone-2,6-disulfonate (AH 2 QDS) on the kidneys of paraquat (PQ) poisoned rats via the apelin-APJ pathway. Methods: Male Sprague Dawley rats were divided into four experimental groups: control, PQ, PQ+sivelestat, and PQ+AH 2 QDS. The PQ+sivelestat group served as the positive control group. The model of poisoning was established via intragastric treatment with a 20% PQ pesticide solution at 200 mg/kg. Two hours after poisoning, the PQ+sivelestat group was treated with sivelestat, while the PQ+AH 2 QDS group was given AH 2 QDS. Six rats were selected from each group on the first, third, and seventh days after poisoning and dissected after anesthesia. The PQ content of the kidneys was measured using the sodium disulfite method. Hematoxylin-eosin staining of renal tissues was performed to detect pathological changes. Apelin expression in the renal tissues was detected using immunofluorescence. Western blotting was used to detect the expression levels of the following proteins in the kidney tissues: IL-6, TNF-α, apelin-APJ (the apelin-Angiotensin receptor), NF-κB p65, caspase-1, caspase-8, glucose-regulated protein 78 (GRP78), and the C/EBP homologous protein (CHOP). In in vitro study, a PQ toxicity model was established using human tubular epithelial cells treated with standard PQ. Twenty-four hours after poisoning, sivelestat and AH 2 QDS were administered. The levels of oxidative stress in human renal tubular epithelial cells were assessed using a reactive oxygen species fluorescence probe. Results: The PQ content in the kidney tissues of the PQ group was higher than that of the PQ+AH 2 QDS group. Hematoxylin-eosin staining showed extensive hemorrhage and congestion in the renal parenchyma of the PQ group. Vacuolar degeneration of the renal tubule epithelial cells, deposition of crescent-like red staining material in renal follicles, infiltration by a few inflammatory cells, and a small number of cast formation were also observed. However, these pathological changes were less severe in the PQ+sivelestat group and the PQ+AH 2 QDS group (P<0.05). On the third day after poisoning, immunofluorescence assay showed that the level of apelin in the renal tissues was significantly higher in the PQ+AH 2 QDS group than in the PQ group. Western blotting analysis results showed that IL-6, TNF-α, NF-κB p65, caspase-1, caspase-8, GRP78, and CHOP protein levels in the PQ group were higher than in the PQ+AH 2 QDS group (P<0.05). The expression of apelin-APJ proteins in the PQ+AH 2 QDS group was higher than in the PQ+sivelestat and PQ groups (P<0.05); this difference was significant on Day 3 and Day 7. The level of oxidative stress in the renal tubular epithelial cells of the PQ+AH 2 QDS group and the PQ+sivelestat group was significantly lower than in the PQ group (P<0.05). Conclusions: This study confirms that AH 2 QDS has a protective effect on PQ-poisoned kidneys and its positive effect is superior to that of sivelestat. The mechanism of the protective effects of AH 2 QDS may be linked to reduction in cellular oxidative stress, PQ content of renal tissue, inflammatory injury, endoplasmic reticulum stress, and apoptosis. AH 2 QDS may play a role in the treatment of PQ poisoning by upregulating the expression of the apelin-APJ.

Objective To investigate the growth, development and health management of children with type 1 diabetes, and to provide guidance for the treatment of children with type 1 diabetes. Methods From June 2018 to June 2021, 86 children with type 1 diabetes diagnosed and treated in the Department of Endocrinology of our hospital from January 2000 to December 2002 were selected, including 41 males and 45 females, the onset age of 6-9 years old, all of whom were followed up by telephone. Height, weight, age of onset of youth, age of menarche, blood glucose control and complications were recorded and analyzed from onset to adulthood. Results The initial height of children were lower than those of children of the same age (P<0.05), and there was no difference in height between children of the same age and children of the same age when they reached lifetime height (P>0.05).The median age of initiation of puberty in boys was (12.10±1.50) years later than that in the general population (P<0.05), and the median age of initiation of puberty and menarche in girls were (11.20±1.40) years and (14.90±2.10) years later than that in the general population (P<0.05). 11.63% (10/86) of children HbAl-c <7.0%, 30.23% (26/86) in children with HbAl-c is 7.00% -8.00%, 58.14% (50/86) in children with HbAl-c > 8.0%. There were 1 (1.16%) cases of retinopathy and 4 (4.65%) cases of microalbuminuria. 84 cases (97.67%) were monitored for blood glucose or urine glucose, and only 2 cases were not monitored. Conclusion Due to poor self-control and growth, the blood glucose control of children with type 1 diabetes is often not ideal. Although complications are rare, most blood glucose control is not ideal and blood glucose detection is not enough. Therefore, It is necessary to strengthen the publicity and education of diabetes and regularly monitor blood glucose.

AIM: To evaluate the diagnostic performance of the isolated-checked visual evoked potential(IC-VEP)in the detection of open angle glaucoma and compared it to the blue-yellow perimetry(B/YP)and optical coherent tomography(OCT).

METHODS: In a retrospective analysis, IC-VEP, perimetry and OCT were performed on 101 subjects(n=35, normal; n=30, early glaucoma; n=36, moderate and advanced glaucoma)from China. The sensitivity of IC-VEP, perimetry and OCT for detection of glaucoma, as well as the agreement within these 3 methods, were calculated to evaluate their clinic performance.

RESULTS: In the early primary open angle glaucoma(POAG)group the sensitivity of IC-VEP, blue-yellow perimetry and OCT were 70.00%, 70.00% and 63.33%, respectively. In the moderate advanced POAG group, the sensitivity of IC-VEP, OCT and blue-yellow perimetry were 86.11%, 88.89% and 91.67%, respectively. The specificity of IC-VEP was 91.43%. The results of IC-VEP were highly consistent with OCT and blue-yellow visual field tests(kappa: 0.721-1.000, P<0.05).

CONCLUSION:As an objective examination of visual function, IC-VEP can be used for early diagnosis of glaucoma. It may be a useful tool for monitoring the function of RGCs in suspected glaucoma patients.

嵌合抗原受体T（chimeric antigen receptor T， CAR-T）细胞是一种通过基因工程表达受体的T细胞，能够识别特定的抗 原，是目前最具潜力的靶向肿瘤治疗方法。然而，作为抗癌免疫系统中主要效应细胞之一的CD8+T细胞在肿瘤中发挥作用时， 通 常处于耗竭状态，而这种功能缺陷的CD8+T细胞是杀伤肿瘤的障碍。肿瘤微环境（tumor microenvironment，TME）中存在许多抑 制性因素，例如耗竭性T细胞表面高表达的抑制性受体、免疫抑制细胞群、抑制性因子、转录因素、代谢因素等都对T细胞的分化 及耗竭有重要影响。当然， CAR的结构和共刺激域也对CAR-T细胞整体功能发挥着重要作用。本文着重总结近年有关CD8+T 细胞耗竭的机制及改善策略的研究进展，为增强CAR-T细胞的抗肿瘤效应提供了潜在思路。

Objective： ：To study the regulatory effect of mogrol (MO) on lipid metabolism of hepatic cancer cells and its molecular mechanism. Methods: Oleic acid (OA) was used to induce fat accumulation in hepatocellular carcinoma HepG2 cells and to establish a steatosis cell model. CCK-8 method was used to detect the cytotoxicity of MO to HepG2 cells, and an experimental working concentration without obvious cytotoxicity of MO was chosen. After being treated with different concentrations of MO, lipid accumulation in the cells was observed by oil red O staining, and the contents of triglyceride (TG) and cholesterol (TC) in the cells were measured. Key genes involving in lipid metabolism were screened out by high-throughput transcriptome sequencing qPCR was used to detect the mRNA expressions of ,SREBP-1c and FASN, while Western Blot was used to detect the protein expressions of p-AMPKα, SREBP-1c and FASN in cells of model group and treatment group. Results: After OA induction, a large amount of lipids accumulated in HepG2 cells, the contents of TG and TC increased significantly. Three key genes (SREBP-1c, FASN and p-AMPK α) involving in lipid metabolism of hepatic cancer cells were screened out. After OA induction, the mRNA expressions of SREBP-1c and FASN increased, the protein expression of p-AMPK α decreased while the protein expressions of SREBP-1c, FASN and other proteins increased significantly. After intervention with working concentration of MO, intracellular lipid accumulation, contents of TG and TC, mRNA expressions of SREBP-1c, FASN and protein expressions of SREBP-1c, FASN decreased significantly, while the expression of p-AMPKα increased. Conclusion: Mogrol can inhibit the synthesis of fatty acids by activating the expression level of AMPK signaling pathway related factors SREBP-1c and FASN, so as to play the role of regulating lipid metabolism.