Objective:To investigate effect of acacetin on alveolar epithelial cell damage caused by Streptococcus pneumoniae(SP)infection by regulating sirtuin 1(Sirt1)-mediated 5'-AMP activated protein kinase(AMPK)/nuclear factor erythroid-2 related factor 2(Nrf2)signaling pathway.Methods:Alveolar epithelial cells A549 cultured in vitro were infected with SP to establish a cell damage model.After treatment with acacetin at final concentrations of 0,5,25,50,100,150,200 μmol/L,CCK-8 was performed to detect cell viability of each treatment group and optimal concentration of acacetin was screened.A549 cells cultured in vitro were ran-domly separated into five groups:control group,model group,acacetin(150 μmol/L)group,EX527(Sirt1 inhibitor,40 μmol/L)group,acacetin(150 μmol/L)+EX527(40 μmol/L)group,control group was not treated,other groups were infected with SP to establish a cell damage model,and then treated with 150 μmol/L acacetin and 40 μmol/L EX527,CCK-8 and flow cytometry were performed to measure cell viability and apoptosis rate in each group;kits were performed to measure levels of reactive oxygen species(ROS),superoxide dismutase(SOD),malondialdehyde(MDA),lactate dehydrogenase(LDH)and IL-10,IL-1β,TNF-α levels of cells in each group;Western blot was performed to measure proliferation-related proteins Ki-67,proliferating cell nuclear antigen(PCNA),apoptosis-related proteins caspase-9,Bax,Sirt1 and AMPK/Nrf2 signaling pathway proteins p-AMPK/AMPK,Nrf2 expres-sions of cells in each group.Results:Model group had decreased A549 cell viability,SOD and IL-10 levels,p-AMPK/AMPK,Sirt1,Nrf2,Ki-67 and PCNA protein expressions(P<0.05),and increased apoptosis rate,MDA,LDH,ROS,IL-1β and TNF-α levels than control group(P<0.05).Compared with model group and acacetin+EX527 group,acacetin group had increased A549 cell viability,SOD and IL-10 levels,p-AMPK/AMPK,Sirt1,Nrf2,Ki-67 and PCNA protein expressions(P<0.05),and decreased apoptosis rate,MDA,LDH,ROS,IL-1β and TNF-α levels(P<0.05);EX527 group had decreased A549 cell viability,SOD and IL-10 levels,p-AMPK/AMPK,Sirt1,Nrf2,Ki-67 and PCNA protein expressions(P<0.05),and increased apoptosis rate,MDA,LDH,ROS,IL-1β and TNF-α levels(P<0.05).Conclusion:Acnestin can activate AMPK/Nrf2 signaling by up-regulating Sirt1 expression,thereby promoting secretion of anti-inflammatory factors,reducing production of ROS and pro-inflammatory factors,reducing inflammation and oxidative stress,and finally alleviating neuronal damage.

Glioblastoma (GBM) is the most common and aggressive malignant brain tumor in adults and is poorly controlled. Previous studies have shown that both macrophages and angiogenesis play significant roles in GBM progression, and co-targeting of CSF1R and VEGFR is likely to be an effective strategy for GBM treatment. Therefore, this study developed a novel and selective inhibitor of CSF1R and VEGFR, SYHA1813, possessing potent antitumor activity against GBM. SYHA1813 inhibited VEGFR and CSF1R kinase activities with high potency and selectivity and thus blocked the cell viability of HUVECs and macrophages and exhibited anti-angiogenetic effects both in vitro and in vivo. SYHA1813 also displayed potent in vivo antitumor activity against GBM in immune-competent and immune-deficient mouse models, including temozolomide (TMZ) insensitive tumors. Notably, SYHA1813 could penetrate the blood-brain barrier (BBB) and prolong the survival time of mice bearing intracranial GBM xenografts. Moreover, SYHA1813 treatment resulted in a synergistic antitumor efficacy in combination with the PD-1 antibody. As a clinical proof of concept, SYHA1813 achieved confirmed responses in patients with recurrent GBM in an ongoing first-in-human phase I trial. The data of this study support the rationale for an ongoing phase I clinical study (ChiCTR2100045380).

Objective:To observe the changes of the structure and visual function of the retina in patients with or without the ectopic inner foveal layers (EIFL) and to explore the factors influencing the recovery of visual function in patients with idiopathic epimacular membrane (IMEM).Methods:A retrospective clinical study. From March 2015 to June 2019, 90 patients with MEM who were diagnosed by Ophthalmic Center of the Second Hospital of Hebei Medical University were enrolled in the study. All patients were examined by best corrected visual acuity (BCVA) and frequency domain optical coherence scan. BCVA was recorded by Snellen vision table, and it was converted into the minimum resolution angle logarithm (logMAR) vision. Among 90 eyes, IMEM grade 2-4 was 68 (75.6%, 68/90), 18 (20.0%, 18/90), 4 (4.4%, 4/90), respectively. According to this, the grade 2 was set as group A, and the grade 3 and grade 4 were combined to group B. There was no significant difference in age ( t=0.015), sex composition ratio of patients between two groups ( χ2=0.060) and the average of central macular thickness (CMT) ( F=2.277) ( P=0.904, 0.809, 0.141). The difference of average logMAR and BCVA was statistically significant ( F=35.913, P=0.000). All patients underwent 25G pars plana three channel vitrectomy with simultaneous removal of epiretinal membrane and internal limiting membrane. BCVA, CMT and improvement of IMEM grading were observed at 1, 3, 6 and 12 months after operation. BCVA, EIFL thickness and CMT were compared before and after operation by single factor repeated variance analysis; Fisher exact probability method was used to compare the changes of the anatomical structure of the eyes in the two groups at 12 months after operation. Results:1, 3, 6, 12 months after operation, the average eyes of logMAR BCVA in group A were 0.50±0.13, 0.38±0.12, 0.27±0.12, 0.19±0.10. The patients in group B were 0.66±0.14, 0.60±0.13, 0.54±0.14, 0.52±0.14. CMT in group A were 364.82±81.29, 281.65±72.45, 228.55±55.34, 182.84±56.13 μm. The patients in group B were 455.88±69.60, 440.18±68.65, 383.76±65.38, 371.39±66.60 μm. The difference was statistically significant in the two groups (BCVA: F=37.913, 11.479, 24.250, 39.013; P=0.000, 0.002, 0.000, 0.000. CMT: F=10.987, 39.610, 55.789, 79.987; P=0.002, 0.000, 0.000, 0.000). In group A, IMEM was improved to 57 eyes of grade 1 on 12 months after operation. Among the 18 eyes in group B, IMEM was improved to 1 and 3 eyes in level 1 and level 2, respectively, and no improvement was found in 4 eyes in grade 4. The difference was statistically significant ( P=0.000) in the improvement of the number of eyes in the two groups. Conclusions:The patients with IMEM without EIFL have better visual prognosis and reversible anatomical changes. EIFL is an important factor affecting the visual function and anatomical structure recovery after operation.

Restless legs syndrome (RLS) is defined as a sleep-wake disorder, with the key feature being an urge to move, which can be classified as two types as primary RLS and secondary RLS. Iron deficiency is a key role of RLS, low levels of serum ferritin is noted in RLS lab tests. Pathophysiology of RLS is complex, genetic variants, anatomical network vulnerability, neurotransmission abnormalities and abnormal dopaminergic neurotransmission may all contribute to its pathogenesis. The mild RLS can choose non-drug therapy, but most of the patients need drug therapy especially the severe cases. The aboved aspects are discussed in this review based on recent literatures.

Objective? To explore the risk factors of severe influenza A H1N1 by the Meta-analysis so as to provide a reference for prevention and control. Methods? Literatures on risk factors of severe influenza A H1N1 were retrieved in Chinese Biomedical Medicine, China national knowledge internet (CNKI), Wanfang Database, VIP Database, PubMed and ProQuest from 1st January 2000 to 31st December 2018 by computer. Quality of literatures were evaluated with the Newcastle-Ottawa Scale (NOS) on standard quality evaluation. Heterogeneity test of literatures was analyzed with the RevMan 5.1, and the odds ratio (OR) and 95% confidence interval (CI) was calculated with the Meta-analysis. Results? A total of 10 literatures were included. Among those literatures, there were 1 852 cases in case group, 3 049 cases in control group and 8 risk factors. Meta-analysis showed that the risk factors of severe influenza A H1N1 included ages ≤5 years (OR=6.09, 95%CI: 1.77-21.16), pregnancy (OR=11.80, 95%CI: 6.91-20.16), chronic underlying disease (OR=3.74, 95%CI: 2.34-5.97), BMI≥ 30 kg/m2 (OR=4.48, 95%CI: 2.81-7.12), time between attack and seeking medical advice≥ 48 h (OR=1.85, 95%CI: 1.50-2.28) and infected with HIV (OR=1.74, 95%CI: 1.33-2.27) with statistical differences (P＜0.001). Influenza vaccination which was a protective factor had a negative influence on incidence of severe influenza A H1N1 (OR=0.63, 95%CI: 0.49-0.82). Conclusions? Risk factors of severe influenza A H1N1 comprise ages≤ 5 years, pregnancy, chronic underlying disease, BMI≥ 30 kg/m2, time between attack and seeking medical advice≥ 48 h and infected with HIV, and influenza vaccination is a protective factor. Influenza vaccination can effectively reduce the incidence of severe influenza A H1N1 or slow down the disease progression. Evidence on gender as a risk factor of severe influenza A H1N1 is insufficient which needs to be tested by later researches.

Objective To acknowledge the NALP3 inflammasome expression and significance in the interstitial cystitis/bladder pain syndrome (IC/PBS).Methods The urine of 16 IC/BPS patients and 16 normal persons was collected to measure the IL-1β content by ELISA.Bladder tissue of 16 IC/BPS patients and para-carcinoma tissue of 16 bladder cancer patients were collected.And the levels of NALP3,caspase1 and IL-1β were detected by Western Blot.60 female rats were randomly divided into control group(bladder was infused with 0.5 ml saline),hyaluronidase group [bladder was infused with 0.5 ml hyaluronidase (4 mg/ml)],NALP3 antagonist group [bladder was infused with 0.5 ml hyaluronidase (4 mg/ml) and Glyburide(10 mg/kg)] and mucosal protectant group [bladder was infused with 0.5 ml hyaluronidase (4 mg/ml) and sodium hyaluronate(0.8 mg/ml)] to carried out the animal experiment,and 15 rats in each group.The models were created by long-term (1 month) intermittent intravesical hyaluronidase infusion.Voiding patterns were investigated by cystometry.Toluidine blue staining was used to detected mast cell’s changes.The levels of NALP3,caspase-1 and IL-1β were determined by Western Blot,HE staining was to detect tissue inflammation of the bladder,and the severity of pain was examined by Von-frey brush by using the strength of 0.07、0.4、1.0 g.The comparison between the chemotaxis of 200 ng,400 ng IL-1β and 200ng SCF IL-1β to mast cells was checked by Transwell experiment.Results The expressions of IL-1β in IC/PBS patients was increased in IC/PBS group than normal control group [(381 ± 112) μg/L vs.(98 ± 40) μg/L,P ＜0.01].The expressions of NALP3,Caspase-1 and IL-lβ had increased in the IC/PBS group than normal group(0.22 ±0.08 vs.0.11 ±0.02,0.25 ±0.03 vs.0.10 ±0.01,0.19 ±0.04 vs.0.11 ± 0.02,P ＜ 0.05)by Western Blot.In the IC/PBS rats,compared with the control group,the intercontraction intervals [(120.0 ± 15.6) s vs.(447.3 ± 24.6) s] and bladder capacity [(0.34 ± 0.02) ml vs.(1.33 ± 0.04) ml] of the model group were significantly decreased (both P ＜ 0.05).In mucosal protectant group and NALP3 antagonist group,the intercontraction intervals [(323 ± 16.3)s,(280 ± 12.5)s] and bladder capacity [(1.14 ± 0.05) ml,(0.84 ± 0.04) ml] were increased compared with control group (P ＜ 0.05).The amount of mast cell in model group were significantly increased than control group (3.4 ±0.8 vs.0.4 ± 0.2,P ＜ 0.05) while in mucosal protectant group (1.8 ± 0.5) and NALP3 antagonist group (1.5 ± 0.7) were decreased compared with control group (P ＜ 0.05).The protein levels in modle group of NALP3 (5.91 ±0.33 vs.1.00 ±0.12),caspase-1 (6.75 ±0.42 vs.1.00 ±0.22) and IL-1β(7.12 ±0.45 vs.1.00 ± 0.18)were increased than control group.In mucosal protectant group and NALP3 antagonist group,theNALP3 (2.921 ±0.21,2.07±0.18),caspase-1 (3.28 ±0.31,2.25 ±0.19) and IL-1β(3.33± 0.41,1.98 ±0.21) were decreased compared with control group.VonFrey pain score in model group were significantly increased than control group(0.07 g:7.5 ± 1.8 vs.2.1 ± 0.5,0.4 g:9.2 ± 1.9 vs.5.2 ± 1.1,1.0g:15.4±3.8 vs.6.8±1.5,P＜0.05) and VonFrey pain score(0.07 g:2.4±0.3,2.8± 0.7;0.4 g:5.2 ±0.4,6.5 ±1.3;1.0 g:6.4 ±0.8,7.3 ±1.1;P＜0.05) in NALP3 antagonist group were significantly decreased.In vitro,Transwell experimental results showed that 400 ng IL-1β of mast cell chemotaxis is similar with that of the 200 ng SCF (3 800 ±400 vs.4 800 ±500,P ＞0.05).Conclusions The levels of NALP3/Caspase-1/IL-1β in the urine of patients with IC/PBS were significantly higher than those in normal control group.NALP3 is activated in chronic cystitis rat model,and related to pain and frequent urination.This may be related to the down-regulation of expression of NALP3,caspase-1,IL-1β,and other inflammatory mediators,and blocking the chemotactic effects of IL-1 β on mast cells.

Objective: To investigate the coping styles and subjective well-being of nurses in the emergency treatment room of grade A tertiary hospitals in a province of China, and to explore the relationship between coping styles and subjective well-being. Methods: In January 2016, 189 nurses in the emergency treatment room were selected from 9 grade A tertiary hospitals in a province of China by random sampling. The general data, coping styles, and subjective well-being of these nurses were analyzed using the general questionnaire, coping style questionnaire, and Campbell index of well-being scale, respectively. Results: The total score of subjective well-being of nurses in the emergency treatment room was 7.54, and the subjective well-being was significantly different between the nurses with different professional titles and between those with different education levels (F=3.46 and 3.47, both P<0.05). The score of illusion coping style differed significantly across the nurses of different ages (F=5.17, P<0.05) , the scores of self-reproach, illusion, and withdrawal coping styles differed significantly across the nurses with different nursing years (F=3.99, 5.30, and 4.97, all P<0.05) , and the score of illusion coping style differed significantly across the nurses with different education levels (F=5.09, P<0.05). Most (71.9%) of the nurses in the emergency treatment room adopted the mature coping style. Subjective well-being was positively correlated with problem-solving, help-seeking, and rationalization (r=0.232, 0.018, and 0.167, all P<0.05) and negatively correlated with withdrawal (r=-0.146, P<0.05) . Conclusion Most nurses in the emergency treatment room adopt the mature coping style. Their subjective well-being and coping style vary with different ages, nursing years, professional titles, and education levels, and the subjective well-being is relatively low.

Objective: Currently, parathyroid hormone (PTH) is mainly measured by the second generation intact PTH (iPTH) assay which detects both full-length (1-84)PTH and (7-84)PTH fragments. The third generation whole PTH (wPTH) assay however has turned out to be specific for (1-84) PTH. The aim of this study is to investigate the features of plasma iPTH, (1-84)PTH, (7-84)PTH levels in patients with stage 5 chronic kidney disease (CKD), and evaluate the effects of parathyroidectomy (PTX) on above markers in severe secondary hyperparathyroidism (SHPT) patients. Methods: A cross-sectional study including 90 controls and 233 stage 5 CKD patients, and a prospective follow-up study in 31 severe SHPT patients were conducted. Plasma iPTH and (1-84)PTH levels were measured by the second and third generation assay, respectively. Circulating (7-84)PTH level was calculated by subtracting the (1-84)PTH value from the iPTH value. Results: Plasma levels of iPTH, (1-84)PTH, (7-84)PTH were higher (P<0.01), and (1-84)PTH/iPTH was lower (P<0.01) in stage 5 CKD patients than in controls. For severe SHPT patients with PTX (n=74), plasma iPTH, (1-84)PTH and (7-84)PTH concentrations were significantly increased compared to non-PTX group (n=159) (P<0.01), and the increase of (7-84)PTH level was more striking than (1-84)PTH. Meanwhile, the value of (1-84)PTH/iPTH was decreased (P<0.01). Plasma iPTH level was strongly correlated with (1-84)PTH level (r=0.980, P<0.01) in stage 5 CKD patients. Also, both iPTH and (1-84)PTH levels were positively correlated with serum alkaline phosphatase, dialysis vintage and serum phosphorus (P<0.01). After PTX (median interval of follow-up: 7.1 months), plasma iPTH, (1-84)PTH, (7-84)PTH concentrations were decreased (by 92.9%, 89.7%, 95.8%, P<0.01, respectively) greatly and (1-84)PTH/iPTH was increased (P<0.01). Conclusions In stage 5 CKD patients, plasma iPTH, (1-84)PTH, (7-84)PTH levels are greatly increased while (1-84)PTH/iPTH is decreased, and PTX can significantly improve abnormality of above markers in severe SHPT patients. The second generation PTH assay overestimates the severity of SHPT, and the accurate measurement of (1-84)PTH by the third assays is more conducive to diagnosis and treatment of CKD and SHPT patients.

Objective To investigate the clinical values of sodium hyaluronate combined arthroscopic joint clean-up surgery for the patellofemoral arthritis knee pain patients.Methods From June 2012 to September 2015 in Taihe Hospital Affiliated to Hubei Medical College,136 patellofemoral arthritis knee pain patients were selected and randomly divided into treatment group (68 cases) and control group (68 cases).All patients were given arthroscopic joint clean-up surgery,the control group were given the postoperative glucosamine sulfate capsules treatment,and the treatment group were given the postoperative intra-articular injection of sodium hyaluronate choose treatment,the treatment period was 5 weeks.Results Five weeks after treatment,the response rates in the treatment group and control group were 98.5％ (67/68) and 89.7％ (61/68),and the effect of the treatment group was better(x2 =4.202,P＜0.05).The pain scores in the treatment and control group were (1.34±0.45) points and (2.89±0.62) points,significandy lower than that of before operation ((7.30 ± 0.76) points and (7.31 ± 0.56) points;t =34.855,25.142;P ＜ 0.05).The Lysholm score in the treatment and control group were (88.87 ± 6.33) points and (76.13 ± 5.98) point,significantly higher than before operation ((44.23 ± 4.29) points and (44.67 ± 5.13) point;t =14.875,8.113;P＜0.05).The incidence of adverse events during the treatment in the treatment group and the control group were 8.8％(6/68) and 13.2％(9/68) respectively,there was no significant differemce between the two groups (x2 =0.391,P＞0.05).All adverse reactions after symptomatic treatment were improved.Conclusion Sodium hyaluronate combined arthroscopic joint clean-up surgery for the patellofemoral arthritis knee pain patients can effectively play the role of promoting the knee pain and function,and has good efficacy and safety,and is worth popularizing and applying.

Objective To investigate the effect of arthroscopic reconstruction of anterior cruciate ligament on the expression of serum osteopontin (OPN) and CD44.Methods Ninety-six cases patients with joint cross ligament injury who were teated in Taihe Hospital Affiliated to Hubei University of Medicine from February 2013 to June 2015 were selected and randomly equally divided into treatment group and control group.Two groups were adopted arthroscopic surgical treatment,and the control group were given the singletunnel reconstruction,the treatment group were given the double-tunnel reconstruction.Results The IKDC scores of 3 months after operation in the treatment group and control group were (92.44±5.13)points and (85.25±4.67) points,both significantly lower than before operation ((57.24 ± 4.19) points,(57.10 ± 4.87)points;P ＜ 0.05)),while there was statistically significant difference between groups (P ＜ 0.05).The total complication rate after 3 months operation in the treatment group was 6.3％,significantly less than that of the control group (35.4％;x2 =5.838,P＜0.05).The OPN expression levels of before and 3 months after operation in the treatment group were (31.98±4.21) μg/L,(7.13±2.89) μg/L,and CD44 were (419.45±20.45) μg/L,(167.24± 18.46) μg/L,the differences were significant (t =34.214,21.774;P＜ 0.05).The OPN expression levels of before and 3 months after operation in the control group were (32.09 ± 3.98) μg/L,(15.98 ± 3.67) μg/L,and CD44 were (421.87 ± 19.45) μg/L,(245.98 ± 20.56) μg/L,the differences were significant (t=21.833,14.099;P＜0.05).There were significant differences on OPN and CD44 of after operation between the two groups (t =12.847,7.498;P＜ 0.05).Conclusion Compare to single-tunnel reconstruction,double-tunnel reconstruction for the anterior cruciate ligament endoscopic surgery can increase restore knee function and reduce postoperative complications,and its mechanism may effectively reduce the levels of OPN and CD44 expression.