Objective To investigate the relationship between the expression of matrix metalloproteinase(MMP)-2,MMP-9,MMP-13 and disease activity in pemphigus patients.Methods A total of 60 pemphigus patients treated in the dermatology department of the hospital from January 2021 to January 2023 were select-ed as the study group,and another 60 healthy volunteers who underwent physical examination in the same pe-riod were recruited as the control group.The levels of MMP-2,MMP-9 and MMP-13 in serum and the expres-sion of MMP-2,MMP-9 and MMP-13 in peripheral blood mononuclear cells were compared between the two groups,and the relationship between the expression of MMP-2,MMP-9 and MMP-13 in peripheral blood mononuclear cells of patients with pemphigus was analyzed.Pemphigus patients were divided into acute phase group(n=22),chronic phase group(n=23)and stable phase group(n=15)according to their disease activi-ty.The expression of MMP-2,MMP-9 and MMP-13 in peripheral blood mononuclear cells of the three groups were compared,as well as the correlation between the three indexes and disease activity.Receiver operating characteristic(ROC)curve was plotted for analysis.Results The levels of MMP-2,MMP-9 and MMP-13 in serum and the expression of MMP-2,MMP-9 and MMP-13 in peripheral blood mononuclear cells in the study group were higher than those in the control group,with statistical significance(P＜0.05).The expression of MMP-2,MMP-9 and MMP-13 in peripheral blood mononuclear cells in severe patients were higher than those in moderate and mild patients,and the difference was statistically significant(P＜0.05).The expression of MMP-2,MMP-9 and MMP-13 and disease activity scores of mononuclear cells in acute attack group were higher than those in chronic attack group,and the differences were statistically significant(P＜0.05).The ex-pression of MMP-2,MMP-9 and MMP-13 in peripheral blood mononuclear cells were positively correlated with disease activity(rMMP-2=0.545,rMMP-9=0.592,rMMP-13=0.580,P＜0.05).ROC curve analysis showed that compared with the single diagnostic efficacy of MMP-2,MMP-9 and MMP-13 expression in peripheral blood mononuclear cells,the three combined diagnostic efficacy was better.Conclusion The expression of MMP-2,MMP-9 and MMP-13 in peripheral blood mononuclear cells of pemphigus patients is related to the disease activity,and these three indicators can be used as reference indicators for the diagnosis of pemphigus disease activity.

Objective:To explore the association between grip strength and cognitive function in elderly people aged 65 years and over.Methods:Information on grip strength, cognitive function, and lifestyle in the elderly population aged 65 years and over in Wuhan was collected by unified professionally trained investigators.A total of 533 study subjects aged(70.7±5.1)years were grouped by quartile into four grip strength groups of Q1(<18.6 kg), Q2(18.6~24.1 kg), Q3(24.2~31.1 kg), Q4(>31.1 kg).Multiple linear regression and Logistic regression analyses were used to analyze the relationship of grip strength with cognitive function scores and cognitive impairment.Results:The mean grip strength of the 533 subjects was(24.94±9.15)kg.After adjusting for sociodemographic characteristics, lifestyle factors, history of diseases, as compared with grip strength Q1 group, the linear regression coefficients(Beta value)of cognitive scores and 95% confidence intervals(95% CI)showed statistically significantly positive correlation[0.45(-0.36, 1.26)、0.40(-0.52, 1.32)and 1.19(0.07, 2.31), all P<0.05]only between cognitive scores and grip strength Q2、Q3 and Q4 value; and the odds ratio and 95% CI of incidence of cognitive impairment were 0.97(0.43, 2.21)for grip strength Q2, 0.79(0.30, 2.06)for grip strength Q3, and 0.22(0.05, 0.92)for grip strength Q4.Considering grip strength as the continuous variable, the risk of cognitive impairment was decreased by 6% and the cognitive score was increased by 0.07 with per 1kg increase of grip strength. Conclusions:The results of this study suggest that there is a positive correlation between grip strength and cognitive function in the elderly population, and a lower grip strength is related to increased risk of cognitive impairment.More attention should be paid to the grip strength of the elderly in the community.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Background: The occurrence of gastrointestinal symptoms in cirrhotic patients with gastroesophageal varices (GOV) after endoscopic treatment is obvious, and the role of gastric myoelectrical activity (GMA) and autonomic nerve function imbalance in the development of gastrointestinal symptoms has not been clarified. Aims: To investigate the changes of GMA and autonomic nerve function in cirrhotic patients with GOV after endoscopic treatment. Methods: Twenty-five cirrhotic patients with GOV from May 2019 to October 2019 at the First Affiliated Hospital of Nanjing Medical University were enrolled, and 10 patients with gastric polyp were served as controls. Electrogastrogram (EGG) and heart rate variability (HRV) were detected before the operation, 1 day after the operation and 5 days after the operation in GOV group. For the gastric polyp group, EGG and HRV were detected before the operation and 1 day after the operation. Changes of GMA and autonomic nerve function were compared between the two groups. Results: No significant differences in GMA and autonomic nerve function were found between GOV group and gastric polyp group before and 1 day after the operation (P>0.05). LF, LF/HF were significantly increased 1 day after the operation in GOV group (P<0.05), while HF was significantly decreased (P<0.01), and the percentage of bradygastria was significantly increased (P<0.01). There were no significant differences in GMA and autonomic nerve function between pre-operation and 5 days after the operation in GOV group (P>0.05). There were no significant differences in GMA and autonomic nerve function 1 day after the operation compared with pre-operation in gastric polyp group (P>0.05). Compared with Child-Pugh A group, Child-Pugh B group had more obvious GMA abnormalities, and the difference was statistically significant (P<0.05). Conclusions: In cirrhotic patients with GOV, the percentage of bradygastria and the sympathetic activity increased, and the vagal activity decreased 1 day after the operation. These results suggest that GMA and autonomic nerve dysfunction may be related to the gastrointestinal symptoms after endoscopic treatment.

Objective: To investigate the correlation between the diversity of biliary bacterial flora and the recurrence of common bile duct stones. Methods: From September 2018 to March 2019, 48 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the First Affiliated Hospital of Nanjing Medical University were enrolled and divided into primary choledocholithiasis (primary group, 38 patients) and recurrent choledocholithiasis group (recurrent group, 10 patients). The bile of the patients of the two groups was collected and analyzed with high-throughput sequencing of 16S rRNA. The Chao1 estimator indicated the richness of the biliary bacterial flora, and Shannon index and Simpson index demonstrated the diversity of biliary bacterial flora. The bacterial flora distribution was explored from different levels of phylum, class, order, family, genus and species. Chi-square test and t test were performed for statistical analysis. Results: The Chao1 estimator of the primary group was higher than that of the recurrent group (419.413±118.704 vs. 396.000±70.483), and the difference was statistically significant (t=3.130, P=0.003). At the level of the phylum, the highest abundance of bacteria in the primary group was Firmicute (56.48%), the highest abundance of bacteria in the recurrent group was Proteobacteria (57.79%). The dominant bacteria of the recurrent group was Proteobacteria, which was inconsistent with that of the primary group, and there were significant differences in the distribution of Proteobacteria and Firmicute between two groups (χ²=0.962 and -2.619, both P<0.05). At the genus level, the abundance of Bacillus and Lactococcus of the recurrent group were both lower than those of the primary group (9.75% vs. 20.77%, 10.86% vs. 22.01%, respectively), and the differences were statistically significant (χ²=0.354 and 0.503, both P<0.05). The abundance of Morganella of the recurrent group was higher than that of the primary group (9.00% vs. 0.44%), and the difference was statistically significant (χ²=-2.025, P=0.049). At the species level, the abundance of Bacillus unclassified, Carnobacterium maltaromaticum and Bacillus circulans of the primary group were all higher than those of the recurrent group (17.78% vs. 8.84%, 2.39% vs. 1.11%, 2.59% vs. 0.74%, respectively), and the differences were all statistically significant (χ²=2.540, 2.643 and 2.515, all P<0.05). The abundance of Aeromonas veronii of recurrent group was higher than that of the primary group (2.04% vs. 0.01%), and the difference was statistically significant (χ²=-2.397, P=0.021). The bacteria that had significant effects in the primary group included Lactococcus (P=0.012), Lactobacillus (P=0.033) and Geobacillus (P=0.021), while in the recurrent group, which included Enterobacter (P=0.007), Aeromonadaceae (P=0.001), Actinomycetes (P=0.009), and Aeromonas (P=0.001). Conclusions There are differences in abundance and composition of biliary bacterial flora between the recurrent group and the primary group. It remains to be further studied whether the changes of some bacterial flora correlated with the recurrence of common bile duct stones.

Background:The incidence of ulcerative colitis (UC)in developed countries is higher than that in developing countries,which may be related with westernized lifestyle,especially high animal protein and low complex carbohydrate diet. With the increased high fat and meat intake,synthesis and secretion of bile acid in liver is also increased,which may have an impact on the occurrence of UC. Aims:To investigate the expressions of farnesoid X receptor (FXR)and G protein-coupled bile acid receptor 5 (TGR5)in patients with UC. Methods:Thirty patients with active UC from January 2013 to June 2016 at the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled,and 30 healthy subjects were served as controls. Expressions of FXR and TGR5 were determined by immunohistochemistry. Results:Compared with control group,expression of FXR was significantly decreased in UC patients (4. 63 ± 2. 07 vs. 6. 91 ± 2. 62,P =0. 00),however,no significant difference in expression of TGR5 was found between the two groups (6. 70 ± 2. 90 vs. 6. 11 ± 2. 44,P = 0. 40). Expression of FXR was significantly increased in right hemicolon colitis than in left hemicolon colitis (P < 0. 05). Conclusions:There is a significant decrease in FXR in active UC patients,indicating that FXR may have some role in the pathogenesis of UC,however,TGR5 may have no obvious effect in the pathogenesis of UC.

Objective To explore the effect of functional electrical stimulation combined with treadmill training and botulinum toxin type A injection on foot-drop and strephenopodia among stroke survivors.Methods Sixty-seven stroke survivors with foot-drop and strephenopodia were randomly divided into an electrical stimulation group (n=23),a conventional treatment group (n =22) and a combined treatment group (n =22).All 3 groups received a 400 U injection of BTX-A and electrical stimulation.After 24 hours,the patients in the conventional treatment group received conventional treatment including a brain protection agent,limb function exercises,gait training,balance training and training in the activities of daily living.The patients in the combined treatment group received that conventional treatment,plus functional electrical stimulation and weight loss training on a treadmill.The patients in the electrical stimulation group received functional electrical stimulation treatment supplementing the conventional treatment.Therapeutic effects were evaluated before and after six weeks of treatment using integral electromyography (iEMS) of the anterior tibial muscle and the lateral head of the gastrocnemius muscle,the co-contraction ratio (CR) during ankle dorsiflexion,the modified Ashworth Scale (MAS),the Berg balance scale (BBS),a functional walking score (FAC),and the active range of motion (AROM) of the ankle in dorsiflexion and eversion.Results After the treatment,significant improvement was observed in all three groups in the average iEMS value of the anterior tibial muscle and the lateral head of the gastrocnemius muscle,the CR in ankle dorsiflexion,and in their MAS,BBS,FAC and AROM results.There was no significant difference among the three groups after treatment in their average iEMS values at the lateral head of the gastrocnemius.The average values of the other indicators were,however,significantly better in the combined treatment group than in the other 2 groups.Conclusion Functional electrical stimulation combined with treadmill training and botulinum toxin type A injection can significantly improve foot-drop,strephenopodia and the walking function of stroke survivors.This combined treatment deserves popularization and application in clinical practice.

Objective To study the therapeutic value of endoscopy for secondary prophylaxis of esophagogastricvariceal bleeding(EGVB).Methods Records of 117 patients with EGVB who were treated with endoscopic ligation and/or histoacryl injection (n =55) and devascularization (n =62) from August 2006 to September 2014 were reviewed.Rebleeding rate,time of rebleeding,incidence of complication,cumulative survival rate,length of ward stay and mean total costs were compared between two groups.Indices were compared according to Child-Pugh.Results The rebleeding rate in the endoscopic group was higher than that in the surgical group[46.2％(24/52) VS 25.0％(15/60),P=0.019] during a mean follow-up of 32.5 months,especially in Child-Pugh B[60.0％(15/25) VS 22.2％(6/27),P=0.006].But the rebleeding time was similar between two groups(P＞0.05).The rate of complications in endoscopic group was lower than that in surgical group [20.0％ (11/55) VS 32.3％ (20/62),P =0.134].No significant difference in cumulative survival rate was observed between the groups (89.1％ VS 87.1％,P＞0.05).The length of ward stay[(14±9)d VS(23±8) d,P＜0.001] and mean total cost[(54 136.79± 44 836.32) yuan VS (73 601.86± 103 403.74)yuan,P＜0.05] in endoscopic group were significantly less than those in surgical group.Conclusion Therapeutic endoscopy is as effective as secondary prophylaxis of esophagogastric variceal bleeding.Endoscopic treatment leads to higher rebleeding rate,but is advantageous in similar rebleeding time,smaller injury,less complications,shorter length of ward stay and lower costs.

Objective To investigate the relationship between heart rate variability ( HRV) and chronic complications in pa-tients with type 2 diabetes mellitus (T2DM).Methods A total of 96 patients with T2DM was given chronic complication assessment . Demographic data were obtained .Diabetic retinopathy , diabetic kidney disease , diabetic peripheral neuropathy ( DPN) , and peripher-al artery disease ( PAD) were diagnosed according to international clinical classification .The parameters of HRV in the patients with diabetes and non-diabetes were examined with24 h Holter recorder .Results The HRV parameters of type 2 diabetic patients were significantly lower than those of non-diabetes ( P <0.05 ) .HRV time domain parameters [ standard deviation of normal RR intervals (SDNN), standard deviation of 5-minute mean RR intervals (SDANN), root mean square difference among successive RR normal in-tervals ( RMSSD) ] were especially impaired in diabetic patients with retinopathy compared to those without retinopathy .HRV parame-ters except low-to-high frequency ratio ( LF/HF) and MNN were lower in diabetic patients with kidney disease than those without kid-ney disease .HRV parameters were no significant difference between patients with or without PAD .Conclusions HRV of diabetic pa-tient is lower.Diabetic retinopathy and kidney disease impact on the HRV .