OBJECTIVE To study the ameliorative effect and potential mechanism of curcumin on diabetes model rats with depression based on cAMP response element binding protein （CREB）/brain-derived neurotrophic factor （BDNF） signaling pathway. METHODS The diabetes model rat with depression was established by high fat and high sugar diet+intraperitoneal injection of streptozotocin+chronic unpredictable stress-induced depression. The successfully modeled rats were randomly divided into model group， positive control group （0.18 g/kg metformin and 1.8 mg/kg fluoxetine， gavage）， curcumin low-dose and high-dose groups （30， 60 mg/kg， gavage） and curcumin high-dose+CREB inhibitor group [60 mg/kg curcumin （gavage）+5 mg/kg CREB inhibitor 666-15 （intraperitoneal injection）]， with 12 rats in each group. Another 12 healthy rats were selected as the normal group. Each group was given a corresponding intervention for 4 weeks， the fasting blood glucose level of rats was detected， and the depression of rats was assessed. The levels of corticosterone （CORT） and inflammatory factors [tumor necrosis factor-α （TNF-α）， interleukin- 1β （IL-1β）， IL-6] in serum， and the levels of norepinephrine （NE） and 5-hydroxytryptamine （5-HT） in hippocampal tissue were determined. The pathological changes and neuronal apoptosis were observed in the hippocampal tissue of rats in each group； the expression levels of CREB， BDNF mRNA and protein in hippocampal tissue were detected. RESULTS Compared with the normal group， the hippocampal tissue of rats in the model group was severely damaged， and neurons were scattered， while the fasting blood glucose， the forced swimming immobility time， the tail suspension immobility time， serum levels of CORT， TNF-α， IL-1β and IL-6， and neuron apoptosis indexes were all increased or prolonged significantly （P＜0.05）. The levels of NE and 5-HT， the number of surviving neurons， and the expression levels of CREB and BDNF mRNA and protein in hippocampal tissue were decreased significantly （P＜0.05）. Compared with the 的model group， the damage to hippocampal tissue was relieved in the positive control group and curcumin groups， while the above indexes were improved significantly （P＜0.05）. The improvement effect of curcumin high-dose group was better than that of curcumin low-dose group （P＜0.05）. CREB inhibitor could significantly reverse the ameliorative effect of high-dose curcumin on the model rats （P＜0.05）. CONCLUSIONS Curcumin can improve the depression of diabetes model rats with depression， and relieve neuronal damage and inflammatory response， the mechanism of which may be associated with activating CREB/BDNF signaling pathway.

Colorectal cancer is a common clinical malignant tumor. As the main therapeutic method of colorectal cancer, radiotherapy has a good inhibitory effect on tumor progression. In recent years, because of its good physical and biological advantages, carbon ion has shown better clinical efficacy than traditional radiotherapy in the treatment of local recurrence or distant metastasis of colorectal cancer. In this article, basic and clinical studies related to the efficacy of carbon ion therapy for the recurrence of colorectal cancer in recent years were reviewed, aiming to provide theoretical basis for preventing and reducing adverse reactions after radiotherapy and prolonging the survival of colorectal cancer patients.

Objective:To investigate respiratory virus infection in children with septic shock in pediatric care units (PICU) in China and its influence on clinical outcomes.Methods:The clinical data of children with septic shock in children′s PICU from January 2018 to December 2019 in 10 Chinese hospitals were retrospectively collected. They were divided into the pre-COVID-19 and post-COVID-19 groups according to the onset of disease, and the characteristics and composition of respiratory virus in the 2 groups were compared. Matching age, malignant underlying diseases, bacteria, fungi and other viruses, a new database was generated using 1∶1 propensity score matching method. The children were divided into the respiratory virus group and non-respiratory virus group according to the presence or absence of respiratory virus infection; their clinical characteristics, diagnosis, and treatment were compared by t-test, rank sum test and Chi-square test. The correlation between respiratory virus infection and the clinical outcomes was analyzed by logistic regression. Results:A total of 1 247 children with septic shock were included in the study, of them 748 were male; the age was 37 (11, 105) months. In the pre-and post-COVID-19 groups, there were 530 and 717 cases of septic shock, respectively; the positive rate of respiratory virus was 14.9% (79 cases) and 9.8% (70 cases); the seasonal distribution of septic shock was 28.9% (153/530) and 25.9% (185/717) in autumn, and 30.3% (161/530) and 28.3% (203/717) in winter, respectively, and the corresponding positive rates of respiratory viruses were 19.6% (30/153) and 15.7% (29/185) in autumn, and 21.1% (34/161) and 15.3% (31/203) in winter, respectively. The positive rates of influenza virus and adenovirus in the post-COVID-19 group were lower than those in the pre-COVID-19 group (2.1% (15/717) vs. 7.5% (40/530), and 0.7% (5/717) vs. 3.2% (17/530), χ2=21.51 and 11.08, respectively; all P<0.05). Rhinovirus virus were higher than those in the pre-Covid-19 group (1.7% (12/717) vs. 0.2% (1/530), χ2=6.51, P=0.011). After propensity score matching, there were 147 cases in both the respiratory virus group and the non-respiratory virus group. Rate of respiratory failure, acute respiratory distress, rate of disseminated coagulation dysfunction, and immunoglobulin usage of the respiratory virus group were higher than those of non-respiratory virus group (77.6% (114/147) vs. 59.2% (87/147), 17.7% (26/147) vs. 4.1% (6/147), 15.6% (25/147) vs. 4.1% (7/147), and 35.4% (52/147) vs. 21.4% (32/147); χ2=11.07, 14.02, 11.06 and 6.67, all P<0.05); and PICU hospitalization of the former was longer than that of the later (7 (3, 16) vs. 3 (1, 7)d, Z=5.01, P<0.001). Univariate logistic regression analysis showed that the presence of respiratory viral infection was associated with respiratory failure, disseminated coagulation dysfunction, the use of mechanical ventilation, and the use of immunoglobulin and anti-respiratory viral drugs ( OR=2.42, 0.22, 0.25, 0.56 and 1.12, all P<0.05). Conclusions:The composition of respiratory virus infection in children with septic shock is different between pre and post-COVID-19. Respiratory viral infection is associated with organ dysfunction in children with septic shock. Decreasing respiratory viral infection through respiratory protection may improve the clinical outcome of these children.

Objective:To investigate the clinical features, pathogen composition, and prognosis of septic shock in pediatric intensive care units (PICU) in China.Methods:A multicenter retrospective cohort study. A retrospective analysis was conducted on the clinical data of children with septic shock from 10 hospitals in China between January 2018 and December 2021. The clinical features, pathogen composition, and outcomes were collected. Patients were categorized into malignant tumor and non-malignant tumor groups, as well as survival and mortality groups. T test, Mann Whitney U test or Chi square test were used respectively for comparing clinical characteristics and prognosis between 2 groups. Multiple Logistic regression was used to identify risk factors for mortality. Results:A total of 1 247 children with septic shock were included, with 748 males (59.9%) and the age of 3.1 (0.9, 8.8) years. The in-patient mortality rate was 23.2% (289 cases). The overall pathogen positive rate was 68.2% (851 cases), with 1 229 pathogens identified. Bacterial accounted for 61.4% (754 strains) and virus for 24.8% (305 strains). Among all bacterium, Gram negative bacteria constituted 64.2% (484 strains), with Pseudomonas aeruginosa and Enterobacter being the most common; Gram positive bacteria comprised 35.8% (270 strains), primarily Streptococcus and Staphylococcus species. Influenza virus (86 strains (28.2%)), Epstein-Barr virus (53 strains (17.4%)), and respiratory syncytial virus (46 strains (17.1%)) were the top three viruses. Children with malignant tumors were older and had higher pediatric risk of mortality (PRISM) Ⅲ score, paediatric sequential organ failure assessment (pSOFA) score (7.9 (4.3, 11.8) vs. 2.3 (0.8, 7.5) years old, 22 (16, 26) vs. 16 (10, 24) points, 10 (5, 14) vs. 8 (4, 12) points, Z=11.32, 0.87, 4.00, all P<0.05), and higher pathogen positive rate, and in-hospital mortality (77.7% (240/309) vs. 65.1% (611/938), 29.7% (92/309) vs. 21.0% (197/938), χ2=16.84, 10.04, both P<0.05) compared to the non-tumor group. In the death group, the score of PRISM Ⅲ, pSOFA (16 (22, 29) vs. 14 (10, 20) points, 8 (12, 15) vs. 6 (3, 9) points, Z=4.92, 11.88, both P<0.05) were all higher, and presence of neoplastic disease, positive rate of pathogen and proportion of invasive mechanical ventilation in death group were also all higher than those in survival group (29.7% (87/289) vs. 23.2% (222/958), 77.8% (225/289) vs. 65.4% (626/958), 73.7% (213/289) vs. 50.6% (485/958), χ2=5.72, 16.03, 49.98, all P<0.05). Multiple Logistic regression showed that PRISM Ⅲ, pSOFA, and malignant tumor were the independent risk factors for mortality ( OR=1.04, 1.09, 0.67, 95% CI 1.01-1.05, 1.04-1.12, 0.47-0.94, all P<0.05). Conclusions:Bacterial infection are predominant in pediatric septic shock, but viral infection are also significant. Children with malignancies are more severe and resource consumptive. The overall mortality rate for pediatric septic shock remains high, and mortality are associated with malignant tumor, PRISM Ⅲ and pSOFA scores.

Oral microbiota is the second largest microbiota in the human body. Due to its unique ecological environment, oral microbiota can affect oral health and whole body condition in various ways. With the progress of research, the role of oral microbiota in cardiocerebrovascular diseases is gradually being understood. At present, it is believed that oral microbiota can affect ischemic stroke through microbiota transfer, metabolites production, systemic inflammation, and other mechanisms. This article reviews the correlation and possible mechanisms between oral microbiota and ischemic stroke.

Objective To investigate the protective effect and molecular mechanism of bloodletting acupuncture at Jing-well points on acute high-altitude hypoxia brain injury through regulating PI3K/AKT/mTOR signaling pathway-mediated mitochondrial autophagy,and to provide an effective target and theoretical basis for the clinical use of bloodletting acupuncture at Jing-well points to prevent and treat acute high-altitude hypoxia brain injury.Methods Male SD rats were randomly divided into Control group(n=15)and experimental group,and the experimental group was divided into Model group(n=15),Bloodletting Acupuncture at Jing-well Points of hand group(BAJP group,n=15),Bloodletting Acupuncture at Non-Acupoint group(BANA group,n=15).The low pressure oxygen chamber was depressurized to 6000 m altitude,and the rats in each experimental group were treated with low-pressure hypoxia for 72 h to replicate the acute high-altitude hypoxia brain injury rat model.The rats in the BAJP group were bled according to the order of"Shaoshang"(LU11),"Shangyang"(LI1),"Zhongchong"(PC9),"Guanchong"(SJ1),"Shaochong"(HT9),"Shaoze"(SI1),once a day for 7 days.The rats in the BANA group were bled by cutting the tail tip daily,and the amount of blood bled was 15-20 μL in both groups.The expression levels of PI3K,AKT and mTOR in hippocampal tissues of rats were detected by Western blot;AKT and mTOR mRNA expression levels in hippocampal tissues of rats were detected by PCR.Results Compared with the Control group,the number of degenerative necrotic vertebral cells in CA1 area of hippocampal tissue,swelling of mitochondria,appearance of autophagosomes,and increase of apoptosis in hippocampal tissue of Acute High-altitude Hypoxia(AHH)rats were significantly increased;After bloodletting acupuncture at Jing-well points of hand treatment,various brain injury manifestations in AHH rats were alleviated;Bloodletting acupuncture at non-acupoint had no significant ameliorating effect on AHH rats′ brain injury.Western blot detected a significant decrease in the phosphorylation levels of PI3K,AKT,and mTOR in the hippocampal tissues of AHH rats compared to Control group rats(P<0.01),and the phosphorylation levels of the three molecules were further decreased after bloodletting acupuncture at Jing-well points of hand treatment(P<0.01),and bloodletting acupuncture at non-acupoint treatment did not have significantly affect on the phosphorylation levels of these molecules(P>0.05),and AKT,mTOR mRNA expression levels further demonstrated the above trend.Conclusion Bloodletting acupuncture at Jing-well points of hand can play a protective role against acute high-altitude hypoxia brain injury with points specificity,and the mechanism may be related to the inhibition of PI3K/AKT/mTOR pathway to promote the elevated level of mitochondrial autophagy,improve mitochondrial physiology,and enhance the body′s ability to resist apoptosis and hypoxia.

Objective:To explore the relationship between drug evidence and core prescription for depression.Methods:We retrieved literature of TCM for depression from CNKI, VIP and Wangfang databases to November 2019, 30th as well as there cords from Ancient and Modern Medical Records Cloud Platform (V 1.5). The Excel 2010 was used to establish the standardized database of medical records. After the standardization of medicines, Ancient and Modern Medical Records Cloud Platform (V1.5) statistics methodswere used for association rules analysis, complex networks, and analysis of drugs’ frequency, medical characteristics, core prescription drugs.Results:A total of 632 effective prescriptions were included, involving a total of 527 drugs. The results of frequency of herbs showed that 23 kinds of high-frequency herbs were obtained. Bupleuri Radix was the most frequently used medicine. Most herbs are warm or flat, with pungent, sweet and bitter in taste, belonging to the lung, liver, heart and spleen meridians. A total of 25 drug-pair association and 13 TCM association were obtained by association rule analysis. Conclusions:TCM treatment for depression is mainly based on soothing the liver and regulating qi, clearing the heart and calming the nerves. Bupleuri Radix, Curcumae Radix, Paeoniae Radix Alba, Chuanxiong Rhizoma, Ziziphi Spinosae Semen are the basic prescriptions. Angelicae Sinensis Radix, Ophiopogonis Radix, Albiziae Cortex, Polygalae Radix, Poria are used as reference.

Objective:The study was to explore the nipple-areola complex(NAC) blood supply model in Chinese breasts based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to provide the blood supply knowledge for mammaplasty.Methods:Breast DCE-MRI images of breasts without masses in 245 patients from March 2012 to October 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology were included retrospectively. The breast vessels images were obtained by image subtraction in the Siemens workstation. Axial, coronal and sagittal maximum intensity projection(MIP) images were evaluated, and all vessels supplying the nipple-areola complex were identified by 3D MIP images. Blood supply to the NAC was classified into 9 zones, and vessels of each zone were counted and analyzed. The maximum distance from the vessel to the skin surface of the breast was measured. SPSS 19.0 software was used for statistical analysis. The chi-square test was used to check for significant differences in the distribution of zones between the left breasts and the right breasts. The mean, standard deviation and 95% confidence interval of the distance between vessels and skin were calculated. Using ANOVA to compare the distance between vessels and skin of zones. P<0.05 was statistically significant. Results:There were 490 breasts in 245 DCE-MRI images, of which 97 breasts were found to have masses in 97 DCE-MRI images. The remaining 393 were normal breasts as study subjects. The patients’ ages ranged from 23 to 72 years, with a mean of 43.7 years. 637 source vessels (311 left, 326 right) were identified in 393 breasts (200 left, 193 right). Of the 637 vessels, 269 (42.2%) were in the superomedial zone and 180 (28.3%) were in the superolateral zone. The proportions of vessels in zone medial (57, 8.9%), inferior (37, 5.8%), central (30, 4.7%), inferomedial (25, 3.9%), inferolateral (25, 3.9%), superior (11, 1.7%) and lateral (3, 0.5%) were less than 10%, respectively. The chi-square test showed no significant difference in the distribution of zones ( χ2 =6.4, P=0.602) between the left breasts and the right breasts. Except for the central zone, the mean of maximum distance from the vessels to the skin surface was 0.91 cm, with a 95% confidence interval of 0.86 cm to 0.96 cm. Conclusions:DCE-MRI can clearly show the blood supply to the NAC. Superomedial or superolateral source vessels supplying the NAC were predominant, and the vessels run at a subcutaneous depth of about 1 cm.

Objective:The study was to explore the nipple-areola complex(NAC) blood supply model in Chinese breasts based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and to provide the blood supply knowledge for mammaplasty.Methods:Breast DCE-MRI images of breasts without masses in 245 patients from March 2012 to October 2019 in Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology were included retrospectively. The breast vessels images were obtained by image subtraction in the Siemens workstation. Axial, coronal and sagittal maximum intensity projection(MIP) images were evaluated, and all vessels supplying the nipple-areola complex were identified by 3D MIP images. Blood supply to the NAC was classified into 9 zones, and vessels of each zone were counted and analyzed. The maximum distance from the vessel to the skin surface of the breast was measured. SPSS 19.0 software was used for statistical analysis. The chi-square test was used to check for significant differences in the distribution of zones between the left breasts and the right breasts. The mean, standard deviation and 95% confidence interval of the distance between vessels and skin were calculated. Using ANOVA to compare the distance between vessels and skin of zones. P<0.05 was statistically significant. Results:There were 490 breasts in 245 DCE-MRI images, of which 97 breasts were found to have masses in 97 DCE-MRI images. The remaining 393 were normal breasts as study subjects. The patients’ ages ranged from 23 to 72 years, with a mean of 43.7 years. 637 source vessels (311 left, 326 right) were identified in 393 breasts (200 left, 193 right). Of the 637 vessels, 269 (42.2%) were in the superomedial zone and 180 (28.3%) were in the superolateral zone. The proportions of vessels in zone medial (57, 8.9%), inferior (37, 5.8%), central (30, 4.7%), inferomedial (25, 3.9%), inferolateral (25, 3.9%), superior (11, 1.7%) and lateral (3, 0.5%) were less than 10%, respectively. The chi-square test showed no significant difference in the distribution of zones ( χ2 =6.4, P=0.602) between the left breasts and the right breasts. Except for the central zone, the mean of maximum distance from the vessels to the skin surface was 0.91 cm, with a 95% confidence interval of 0.86 cm to 0.96 cm. Conclusions:DCE-MRI can clearly show the blood supply to the NAC. Superomedial or superolateral source vessels supplying the NAC were predominant, and the vessels run at a subcutaneous depth of about 1 cm.

Objective:This study aimed to explore the use of magnetic resonance imaging (MRI) to measure breast volume and gland volume to guide reconstruction of breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy (NSM).Methods:According to the inclusion criteria, the breast cancer patients admitted to Wuhan Tongji Hospital from September 2018 to June 2019 were selected to undergo breast reconstruction with prosthesis after NSM. Preoperative MRI were used to measure distance from the tumor to the nipple-areola complex and the skin, and estimate the volume of breast and mammary gland. The data of breast volume measured by MRI, gland volume measured by MRI, volume of prosthesis and specimen weight were compared. The data were analyzed using Prism 8.0 software. The paired student t-test was used to compare the difference of two groups. P< 0.05 was considered statistically significant. Linear regression models were used to obtain coefficient of determination ( R2), and R2>0.8 was considered statistically significant. Results:A total of 15 breast cancer patients, aged 28-45 years, with a mean of 35.5 years, were included. There were 13 cases unilateral and 2 cases bilateral. The clinical stages of stage 0, Ⅰ and Ⅱ were 8, 5 and 2 patients, respectively. The average distance o from tumor to nipple-areola complex was (3.1±0.8) cm. One patient suffered postoperative bleeding and was promptly reoperated through the original incision, and the patient recovered well after surgery. All patients felt sensory disturbance of the nipple and areola. There was no complication such as infection, seroma, capsular contracture, prosthesis rupture, and prosthesis shift. At 4-12 months postoperative follow-up, all breasts were basically symmetrical and no tumor recurrence or metastasis occurred, which satisfied the patients. The mean values of the volume of prosthesis, specimen weight, breast volume measured by MRI and gland volume measured by MRI were (471.10±45.60) ml, (244.60±29.14) ml, (243.60±31.16) g, (244.30±16.63) ml. There was significant difference between the breast volume measured by MRI and the specimen weight ( t=10.37, P<0.001), while no statistical difference was found between gland volume measured by MRI and specimen weight ( t=0.20, P=0.847). Similarly, there was significant difference between the breast volume measured by MRI and the volume of prosthesis ( t=5.19, P<0.001), while no statistical difference was found between gland volume measured by MRI and the volume of prosthesis ( t=1.74, P=0.104). The coefficient of determination between gland volume measured by MRI and specimen weight ( R2=0.98) was higher than that of breast volume measured by MRI ( R2=0.82). Similarly, the coefficient of determination between gland volume measured by MRI and the volume of prosthesis ( R2=0.71) was higher than that of breast volume measured by MRI ( R2=0.54). Conclusions:Preoperative MRI can provide guidance to breast reconstruction with silicone gel prothesis following nipple-sparing mastectomy in breast cancer. The gland volume measured by MRI is closer to the specimen weight and the volume of prosthesis than the breast volume measured by MRI.