Extended inflammation and cytokine production pathogenically contribute to a number of inflammatory disorders. Formosanin C (FC) is the major diosgenin saponin  found in herb Paris formosana Hayata (Liliaceae), which has been shown to exert anti-cancer and immunomodulatory functions. In this study, we aimed to investigate anti-inflammatory activity of FC and the underlying molecular mechanism. RAW264.7 macrophages were stimulated with lipopolysaccharide (LPS) or pretreated with FC prior to being stimulated with LPS. Thereafter, the macrophages were subjected to analysis of the expression levels of pro-inflammatory mediators, including nitric oxide (NO), prostaglandin E2 (PGE), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6, as well as two relevant enzymes, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2). The analysis revealed that FC administration blunted LPS-induced production of NO and PGE in a dose-dependent manner, while the expression of iNOS and COX-2 at both mRNA and protein levels was inhibited in LPS-stimulated macrophages pre-treated with FC. Moreover, LPS stimulation upregulated mRNA expression and medium release of TNF-α, IL-1β, and IL-6, whereas this effect was blocked upon FC pre-administration. Mechanistic studies showed that inhibitory effects of FC on LPS-induced inflammation were associated with a downregulation of IκB kinase, IκB, and p65/NF-κB pathway. Taken together, these data suggest that FC possesses an inflammation-suppressing activity, thus being a potential agent for the treatment of inflammation-associated disorders.

Extended inflammation and cytokine production pathogenically contribute to a number of inflammatory disorders. Formosanin C (FC) is the major diosgenin saponin  found in herb Paris formosana Hayata (Liliaceae), which has been shown to exert anti-cancer and immunomodulatory functions. In this study, we aimed to investigate anti-inflammatory activity of FC and the underlying molecular mechanism. RAW264.7 macrophages were stimulated with lipopolysaccharide (LPS) or pretreated with FC prior to being stimulated with LPS. Thereafter, the macrophages were subjected to analysis of the expression levels of pro-inflammatory mediators, including nitric oxide (NO), prostaglandin E2 (PGE), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and IL-6, as well as two relevant enzymes, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2). The analysis revealed that FC administration blunted LPS-induced production of NO and PGE in a dose-dependent manner, while the expression of iNOS and COX-2 at both mRNA and protein levels was inhibited in LPS-stimulated macrophages pre-treated with FC. Moreover, LPS stimulation upregulated mRNA expression and medium release of TNF-α, IL-1β, and IL-6, whereas this effect was blocked upon FC pre-administration. Mechanistic studies showed that inhibitory effects of FC on LPS-induced inflammation were associated with a downregulation of IκB kinase, IκB, and p65/NF-κB pathway. Taken together, these data suggest that FC possesses an inflammation-suppressing activity, thus being a potential agent for the treatment of inflammation-associated disorders.

Objective:To investigate the influence of HBV infection on the prevalence of fatty liver disease in Jinchang cohort and provide theoretical evidence for the prevention and treatment of fatty liver disease.Methods:Epidemiological investigation, laboratory examination and abdominal ultrasound were conducted in the baseline population of Jinchang cohort to collect the basic data, the differences in the prevalence of fatty liver disease under different HBV infection patterns were described and compared and the influence of different HBV infection patterns on the prevalence of fatty liver disease were evaluated by using logistic regression analysis.Results:The baseline Jinchang cohort population totaled 45 605, including 27 917 males and 17 688 females. The male to female ratio was 1.6∶1. The mean age of the overall population was 46.49 years. Among the 8 common HBV infection modes in the Jinchang cohort, the prevalence of fatty liver was low in HBsAg, HBeAg and HBcAb positive, HBsAg and HBcAb positive, and HBsAg, HBeAb and HBcAb positive groups. For 4 serum markers of HBV infection, the prevalence of fatty liver disease in HBsAg and HBeAg positive groups was lower than that in HBsAg and HBeAg negative groups. Logistic regression analysis showed that being HBsAg and HBcAb positive ( OR=0.61, 95% CI: 0.39-0.98) and HBsAg, HBeAg and HBcAb positive ( OR=0.52, 95% CI: 0.30-0.89) could reduce the risk for fatty liver disease. Conclusion:Acute HBV infection reduces the prevalence of fatty liver disease, and the reason may be related to the disturbance of the body's fat metabolism by active HBV replication.

Objective:To explore the influencing factors for non-alcoholic fatty liver disease (NAFLD) in Jinchang cohort, and provide scientific basis for the prevention and control of NAFLD.Methods:A total of 20 051 patients without fatty liver at baseline survey and met the inclusion criteria in Jinchang cohort were selected as study subjects. Prospective cohort study and Cox regression analysis were used to investigate the influencing factors for NAFLD, and the dose-response relationship between related biochemical indicators and NAFLD risk was studied by restricted cubic spline method.Results:The incidence of NAFLD was 42.37/1 000 person years. Multivariate Cox regression analysis showed that being worker and technical personnel (being worker: HR=0.84,95% CI:0.70-0.99;being technical personnel: HR=0.73,95% CI:0.56-0.95), tea drinking (current drinking: HR=0.86,95% CI:0.78-0.94;previous drinking: HR=0.52,95% CI: 0.31-0.86), exercise (occasionally: HR=0.79, 95% CI: 0.68-0.91;frequently: HR=0.60,95% CI:0.52-0.69), low body weight ( HR=0.10, 95% CI: 0.05-0.22), daily intake of dairy products >300 ml/day ( HR=0.78, 95% CI: 0.71-0.87) and HBV infection ( HR=0.77, 95% CI: 0.60-0.99) were the protective factors for NAFLD, while being internal or office workers ( HR=1.84, 95% CI: 1.46-2.31), income ≥2 000 yuan (2 000- yuan: HR=1.32, 95% CI: 1.04-1.66; ≥5 000 yuan: HR=1.72, 95% CI:1.11-2.66), bachelor degree or above ( HR=1.35,95% CI:1.03-1.76), overweight ( HR=2.31, 95% CI:2.08-2.55), obesity ( HR=3.95, 95% CI: 3.42-4.56), impaired fasting blood glucose ( HR=1.31, 95% CI:1.17-1.47), diabetes ( HR=1.53, 95% CI: 1.30-1.80), increased TC ( HR=1.37,95% CI:1.24-1.52), increased TG ( HR=1.79,95% CI: 1.62-1.98), decreased HDL-C ( HR=1.29, 95% CI: 1.14-1.45), increased ALT ( HR=1.13, 95% CI: 1.01-1.26) and high-fat diet ( HR=1.24, 95% CI: 1.11-1.40) were the risk factors for NAFLD. Moreover, TC, TG, HDL-C, ALT and FPG all showed good dose-response relationship with the incidence of NAFLD. Conclusion:Occupation, education level, income level, tea drinking, exercise, BMI, FPG, blood lipid, ALT, HBV infection and diet were related to the incidence of NAFLD.

Objective To explore the effects of six sigma management model in orthopedic robotic surgery training for new nurses of Operating Room. Methods This study selected 20 nurses with entry of 2016 of Operating Room at Henan Provincial People's Hospital in control group,20 nurses with entry of 2017 in experimental group. Control group carried out the orthopedic robotic surgery training with the routine method, while experimental group implemented the training based on the six sigma management model. Examination for new nurses of two groups was carried out with the same examination forms and contents. The investigation adopted the surgeon satisfaction questionnaire and the training satisfaction questionnaire. Results After orthopedic robotic surgery training based on the six sigma management model,the scores of theory knowledge, operational skills and clinical practice of experimental group were(94.72±3.63),(96.95±2.32)and (95.96±2.15)higher than those[(86.41±4.44),(90.15±4.61)and(88.72±4.28)]of control group with statistical differences(P<0.01). After training,surgeon satisfaction with experimental group and control group was(95.56±2.26)and(88.32±4.83)respectively with a statistical difference(P < 0.01). In experimental group,new nurses' satisfaction with training arrangement,training mode,examination,acceptance and total score of satisfaction were(24.08±1.03),(23.78±0.77),(23.95±0.83),(23.71±0.73)and(95.45±1.64) respectively better than those[(21.15±1.14),(21.31±1.21),(21.08±1.04),(20.65±1.23)and(84.22±2.16)] in control group with statistical differences(P< 0.01). Conclusions Six sigma management model can help new nurses of Operating Room to grasp the robotic surgery-related knowledge,increase operation cooperation ability,satisfaction of surgeon and new nurses so as to improve the effects of orthopedic robotic surgery training.

Objective? To understand the self-management status among elderly chronic heart failure (CHF) patients and to compare the regional differences of self-management. Methods? By random cluster sampling, we investigated 6 124 elderly CHF patients from 102 hospitals in five regions, East China (Jiangxi Province, Shanghai Municipality, Zhejiang Province), West China (Qinghai Province, Xinjiang Uygur Autonomous Region, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region, Yunnan Province), South China (Hainan Province, Guangxi Zhuang Autonomous Region), North China (Heilongjiang Province, Inner Mongolia Autonomous Region), Central China (Henan Province, Hubei Province, Hunan Province). The investigation result statistics were carried out and regional differences were compared. Results? The self-management of elderly CHF patients had a low to medium level with 61.25% (49/80) ＜80% for the scoring rate. The scores of East China and Central China were higher and the score of West China was low; the regional differences were statistical (H=59.07, P＜0.01). The score of diet management was highest with 66.67% for the scoring rate (8/12); East China had the highest score, and West China had the lowest score; the regional differences were statistical (H=92.49, P＜0.01). The scoring rate of medication management was 65.00% (13/20) with the highest in East China and low in North China and West China; the regional differences were statistical (H=351.10, P＜0.01). Mental/social adjustment management was poor with 60.00% (12/20) for the scoring rate; the scores of Ease China were higher than those of North and West China; the regional differences were statistical (H=8.84, P＜0.01). Symptom management was the worst with 57.14% (16/28) for the scoring rate; the scores of East and Central China were high;the regional differences were also statistical (H=17.62,P＜0.01). Conclusions? Self-management of elderly CHF patients needs to be improved. Systematic and targeted health education for different regions should be carried out to improve patients' self-management and to reduce the disease burden.

OBJECTIVETo investigate the nutritional status in acute stage ischemic stroke and its relation to disease severity and prognosis of patients.

METHODSFifty patients with ischemic stroke were admitted in hospital within 48 h after onset. National Institute of Health stroke scale (NIHSS) was used to assess the severity of stroke. Physical index and laboratory index were measured on d1, d7 and d14 after admission. Physical index included body weight, body mass index, triceps skin folds, upper arm circumference and arm muscle circumference. Laboratory index included prealbumin, high sensitivity C-reactive protein (hs-CRP), complement C3 and cortisol. The severity of metabolic disturbance was expressed as the difference of biochemical indexes between the d7 and d1. All cases were followed up for 6 months. The prognosis of stroke was evaluated with modified Rankin (mRankin) scores.

RESULTSNo significant changes of physical indexes were found between d7 and d1. The levels of prealbumin and complement C3 on d7 after admission were significantly decreased compared to d1 (198.8 mg/L±20.3 mg/L vs 286.7 mg/L±23.8 mg/L and 0.6 g/L±0.1 g/L vs 1.0 g/L±0.1 g/L, respectively, both P<0.05). The levels of hs-CRP and cortisol at d7 were significantly increased compared to d1 (495.2 nmol/L±39.5 nmol/L vs 24.1 mg/L±5.2 mg/L and 396.4 nmol/L±41.3 nmol/L vs 5.1 mg/L±1.2 mg/L, respectively, both P<0.05). On d14 after admission hs-CRP (13.2 mg/L±4.5 mg/L) and cortisol levels (463.4 nmol/L±32.1 nmol/L) were still significantly higher than d1 (both P<0.05). However, there were no difference in prealbumin (259.2 mg/L±22.8 mg/L) and complement C3 (0.8 g/L±0.2 g/L) levels between d1 and d14 after admission. Correlation analysis revealed that the NIHSS scores and mRankin scores were correlated with nutrition metabolism disturbances (P<0.05).

CONCLUSIONNutrition metabolism disturbances in patients with acute ischemic stroke are related to the disease duration, the severity and prognosis of stroke.

C-Reactive Protein ; metabolism ; Complement C3 ; metabolism ; Humans ; Hydrocortisone ; blood ; Nutritional Status ; Prealbumin ; metabolism ; Prognosis ; Severity of Illness Index ; Stroke ; diagnosis ; physiopathology

Objective To determine the prevalence of penicillinase-producing Neisseria gonorrhoeae(PPNG) and the distribution of blaTEM-135 gene variants in PPNG at several gonococcal antimicrobial surveillance sites in China, to compare N. gonorrhoeae multi-antigen sequence typing(NG-MAST)types of PPNG and its blaTEM-135 gene variants, and to assess the difference and association in NG-MAST types of blaTEM-135 gene variants among different regions. Methods A total of 572 N. gonorrhoeae isolates were collected at 6 gonococcal antimicrobial surveillance sites from Jiangsu, Shanghai, Zhejiang, Tianjin, Guangdong and Guangxi in 2012. After isolation, purification, and identification, cefalotin paper discs were used for detection of PPNG. DNA was extracted by QIAxtractor DX kits after cultivation of the PPNG strains. Then, mismatch amplification mutation assay (MAMA) PCR was performed to identify blaTEM-135 variants, and NG-MAST analysis to determine N. gonorrhoeae genotypes. Results Among the 572 N. gonorrhoeae strains, 38.1%(218/572) were identified as PPNG, and of the PPNG strains, 52.3% (114/218) were blaTEM-135 variants. The detection rate of PPNG at these surveillance sites from high to low was as follows: 51.7% (45/87, Zhejiang), 45.6%(36/79, Shanghai), 38.0% (78/205, Guangdong), 37.5% (12/32, Guangxi), 31.2% (24/77, Jiangsu) and 25.0%(23/92, Tianjin), and that of blaTEM-135 variants was as follows: 68.9%(31/45, Zhejiang), 58.3%(14/24, Jiangsu), 50.0%(39/78, Guangdong), 47.2%(17/36, Shanghai), 39.1%(9/23, Tianjin)and 33.3%(4/12, Guangxi). NG-MAST analysis showed that the ST2318, ST1768, ST1866, ST1053 and ST8726 types predominated among these bla TEM-135 variants, and a strong correlation was found between blaTEM-135 variants and some NG-MAST types, such as ST1768, ST1053 and ST8726 types. The distribution of NG-MAST types was significantly different between the surveillance site in Tianjin (in the Northern part of China) and the other sites (in the Southern part of China), but highly similar among the surveillance sites in Jiangsu, Zhejiang and Shanghai regions. Conclusions There is a high prevalence of PPNG and its blaTEM-135 variants at several gonococcal antimicrobial surveillance sites in China, with significant differences in NG-MAST genotype distribution of PPNG and its blaTEM-135 variants among different regions.