Objective We aimed to compared matrix metalloproteinase-13 (MMP-13) and transforming growth factor-β1 (TGF-β1) in synovial fluid,the phosphorylation level of Smad3 in articular cartilage (P-Smad3),and their correlation with traditional Chinese medicine (TCM) patterns in patients with knee osteoarthritis (KOA) of liver-kidney deficiency pattern and pattern of intermingled phlegm and blood stasis.Methods Using a cross-sectional field investigation method,KOA patients hospitalized in the Orthopedics Department of Dongzhimen Hospital,Beijing University of Chinese Medicine from September 2019 to February 2023 were collected. A total of 112 KOA patients were included,among which 63 cases were diagnosed with liver-kidney deficiency pattern,and 49 cases were diagnosed with pattern of intermingled phlegm and blood stasis. The intensity of knee pain,function,and X-ray imaging result were quantified using the Visual Analogue Scale (VAS),Lysholm Knee Scoring Scale,and Kellgren-Lawrence (K-L) Grading Scale,respectively. The TCM pattern was identified and quantified using a TCM Pattern Scoring Scale. Immunohistochemistry was used to determine the phosphorylation characteristics of Smad3 in articular cartilage,and ELISA was used to measure the contents of MMP-13 and TGF-β1 in synovial fluid. The level characteristics and their correlation with the degree of syndrome were analyzed.Results (i) There was no statistically significant difference in VAS scores,Lysholm scores,and K-L grades between KOA patients with different TCM patterns. (ii) Compared with KOA patients with pattern of intermingled phlegm and blood stasis,patients with pattern of liver-kidney deficiency had higher levels of MMP-13 in synovial fluid and lower levels of TGF-β1 in synovial fluid (P<0.05). (iii) In KOA patients with liver-kidney deficiency pattern,there was a positive correlation between the level of MMP-13 in synovial fluid and the score of TCM pattern (r=0.292,P=0.020),while there was a negative correlation between the level of TGF-β1 in synovial fluid and the score of TCM pattern (r=-0.781,P<0.001). In KOA patients with pattern of intermingled phlegm and blood stasis,there was also a positive correlation between the level of MMP-13 in synovial fluid and the score of TCM pattern (r=0.936,P<0.001). (iv) The mean optical density value of P-Smad3 in articular cartilage was lower in KOA patients with liver-kidney deficiency pattern than in pattern of intermingled phlegm and blood stasis (P<0.05).Conclusion KOA patients with liver-kidney deficiency pattern or pattern of intermingled phlegm and blood stasis have different levels of TGF-β1 and MMP-13 in synovial fluid,as well as varying degrees of Smad3 phosphorylation in articular cartilage,which is consistent with the analysis of etiology and pathogenesis under different patterns. The levels of TGF-β1 and MMP-13 in synovial fluid of patients with liver-kidney deficiency pattern can reflect the severity of the pattern to a certain extent,and the mechanism may be related to the inhibition of the activation level of the TGF-β/Smad signaling pathway. This study enriches the research content of the material basis of TCM patterns.

DRG payment reform is an important means to control the unreasonable growth of medical expenses, improve the quality of medical services and achieve a win-win situation among three sides of hospitals, medical insurance and patients. This study adopted the Smith policy implementation process model to analyze the difficulties in the DRG policy implementation process from four aspects(idealized policies, policy implementation institutions, target groups, and policy environment), including the deviation between policy connotations and actual needs; the interest objectives of all parties were not completely aligned, the target group lacked a sense of identity, and the social impact and technological support needed to be improved. It was suggested that optimization should be carried out from four dimensions: policy supply coordination and precision, performance evaluation and personnel literacy, target group cognitive level and participation willingness, and policy implementation environment and atmosphere, in order to synergistically promote the effective implementation of DRG policies.

Objective To compare the clinical efficacy between Clamshell incision and bilateral posterolateral incision in the sequential double lung transplantation for end-stage lung disease. Methods Clinical data of 120 recipients undergoing double lung transplantation were retrospectively analyzed. All recipients were divided into bilateral posterolateral incision group (n=108) and Clamshell incision group (n=12) according to different surgical methods. Intraoperative parameters were collected and statistically compared between two groups, including operation time, amount of blood loss, amount of blood transfusion, use of extracorporeal membrane oxygenation (ECMO) or not, cold ischemia time on the first side, and cold ischemia time on the second side. Postoperative parameters were also compared between two groups, including the length of hospital stay, length of intensive care unit (ICU) stay, tracheal intubation duration, ECMO duration, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), incidence of anastomotic stenosis, incidence of bronchopleural fistula, perioperative fatality, and 6-minute walk test for the first time after operation. Results In the Clamshell incision group, the amount of blood loss and blood transfusion was significantly higher than those in the bilateral posterolateral incision group (both P < 0.05). The proportion of ECMO and cold ischemia time on the second side in the Clamshell incision group were significantly lower or shorter than those in the bilateral posterolateral incision group (both P < 0.05). In the Clamshell incision group, the tracheal intubation duration and ECMO duration were significantly shorter compared with those in bilateral posterolateral incision group (both P < 0.05). Conclusions Both Clamshell incision and bilateral posterolateral incision are safe and effective in sequential double lung transplantation. Bilateral posterolateral incision approach can significantly reduce the amount of blood loss and blood transfusion of the recipients without significantly prolonging the operation time. Compared with bilateral posterolateral incision approach, the cold ischemia time of lung graft, tracheal intubation duration and ECMO duration are significantly shortened via the Clamshell incision.

Objective:To analyze the composition, the changes of expense structure and the influencing factors of hospitalization expenses, for reference in optimizing the cost control of day surgery.Methods:Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs, chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020. The confounding factors were eliminated through propensity matching. The structural change of hospitalization expenses was analyzed by structural change degree, and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results:After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery, 98 patients with lower extremity varicose veins, 356 patients with chronic cholecystitis and 38 patients with varicocele were finally included. Compared with non day hand, the total hospitalization cost of day surgical instruments decreased, and the cost structure changes of chronic cholecystitis, varicocele and varicose veins of lower limbs were 14.59%, 6.20% and 16.20% respectively. Among them, the general medical service fee, nursing fee and examination and laboratory fee showed a downward trend, and the fees of materials and drugs showed an upward trend. General medical service fee, nursing fee, examination and laboratory fee, clinical diagnosis fee, treatment fee, drug fee, material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90). The payment method, wound healing type and discharge diagnosis can influence the cost of day surgery( P<0.05). Conclusions:Compared with non daytime surgery, the total hospitalization cost of day surgery has a certain cost control effect, but it can not reduce the cost of all projects. The main influencing factors are the internal composition of the cost, payment method and so on. The hospitals should focus on tapping the internal cost control potential of day surgery and further expanding the coverage of day surgery diseases.

OBJECTIVES: To evaluate the effect of echinacoside (ECH) on cognitive dysfunction in post cerebral stroke model rats. METHODS: The post stroke cognitive impairment rat model was created by occlusion of the transient middle cerebral artery (MCAO). The rats were randomly divided into 3 groups by a random number table: the sham group (sham operation), the MCAO group (received operation for focal cerebral ischemia), and the ECH group (received operation for focal cerebral ischemia and ECH 50 mg/kg per day), with 6 rats in each group. The infarct volume and spatial learning were evaluated by triphenyl tetrazolium chloride staining and Morris water maze. The expression of α7nAChR in the hippocampus was detected by immunohistochemistry. The contents of acetylcholine (ACh), malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD), activities of choline acetyltransferase (ChAT), acetylcholinesterase (AChE), and catalase (CAT) were evaluated by enzyme linked immunosorbent assay. The neural apoptosis and autophagy were determined by TUNEL staining and LC3 staining, respectively. RESULTS: ECH significantly lessened the brain infarct volume and ameliorated neurological deficit in infarct volume and water content (both P<0.01). Compared with MCAO rats, administration of ECH revealed shorter escape latency and long retention time at 7, 14 and 28 days (all P<0.01), increased the α7nAChR protein expression, ACh content, and ChAT activity, and decreased AChE activity in MCAO rats (all P<0.01). ECH significantly decreased MDA content and increased the GSH content, SOD, and CAT activities compared with MCAO rats (all P<0.05). ECH suppressed neuronal apoptosis by reducing TUNEL-positive cells and also enhanced autophagy in MCAO rats (all P<0.01). CONCLUSION ECH treatment helped improve cognitive impairment by attenuating neurological damage and enhancing autophagy in MCAO rats.
Acetylcholinesterase ; Animals ; Autophagy ; Brain Ischemia/metabolism* ; Cerebral Infarction ; Cognitive Dysfunction/drug therapy* ; Glutathione/metabolism* ; Glycosides ; Infarction, Middle Cerebral Artery/drug therapy* ; Neuroprotective Agents/therapeutic use* ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury/drug therapy* ; Stroke/drug therapy* ; Superoxide Dismutase/metabolism* ; alpha7 Nicotinic Acetylcholine Receptor

Objective:To observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease.Methods:A prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; >12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, >24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex.Results:The wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, >24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses ( F=8.939, P<0.001). The average difference of wiVD between 12-24 weeks and >24 weeks in the chronic phase was -0.984, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in diVD of patients with different courses of disease ( F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant ( F=8.816, 6.069, 8.943; P<0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was -0.984, -0.230, -0.198, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease ( F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance ( F=47.122, 14.954; P<0.001, <0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD ( r=-0.225, -0.268; P<0.05), and the average thickness of GCC ( r=0.480, 0.436; P<0.01) were all related. Conclusion:The blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.

A new isoquinoline alkaloid(1) has been isolated from the whole plant of Thalictrum glandulosissimum by using various chromatographic techniques, including silica gel, sephadex, MCI-gel resin, and RP-HPLC, and its structure was determined as 1-(6-hydroxy-7-methylisoquinolin-1-yl) ethantone by physicochemical properties and spectroscopic data. This compound was evaluated for anti-tobacco mosaic virus(TMV) activity. The results showed that it had prominent anti-TMV activity with inhibition rates of 28.4%. This rate was closed to that of positive control.
Alkaloids ; Antiviral Agents ; Isoquinolines ; Thalictrum ; Tobacco Mosaic Virus

Artificial Intelligence has been widely applied in cardiovascular diseases. Coronary artery disease, one of the most familiar cardiovascular disease, relies highly on visualized functional tests in its diagnosis and risk stratification, which caters to the advantage of artificial intelligence. Recently, several inspiring results of combining artificial intelligence and related functional tests in diagnosis and risk stratification of coronary artery disease were published worldwide. This review focuses on the application progress of artificial intelligence in diagnosis and risk stratification of coronary artery disease.

Objective: To investigate the effect and mechanism of cinnamaldehyde on the angiogenesis of diabetic retinopathy, and the effect of cinnamaldehyde on vascular endothelial growth factor (VEGF) induced proliferation, migration, tube formation and Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) pathway of EA.hy 926 cells were observed. Method:EA.hy 926 cells were divided into normal control group, model group (7 μg·L^-1 VEGF), and VEGF+cinnamaldehyde group (60, 90, 120, 150 μmol·L^-1). The methyl thiazolyl tetrazolium (MTT) assay and scratch test were used to observe the effect of cinnamaldehyde on the proliferation and migration of EA. hy 926 cells induced by VEGF. EA. hy 926 cells were divided into normal control group, model group (7 μg·L^-1 VEGF), and VEGF+cinnamaldehyde group (90, 150 μmol·L^-1). The tube formation experiment was used to observe the effect of cinnamaldehyde on the tube formation of EA. hy 926 cells induced by VEGF. EA. hy 926 cells were divided into normal control group, model group (7 μg·L^-1 VEGF), VEGF+AG490 group (50 μmol·L^-1), VEGF+cinnamaldehyde group (90 μmol·L^-1), VEGF+cinnamaldehyde group (150 μmol·L^-1), and VEGF+cinnamaldehyde group (150 μmol·L^-1)+AG490 group (50 μmol·L^-1). Western Blot method was used to explore the effect of cinnamaldehyde on the JAK2/STAT3 signaling pathway in EA.hy 926 cells induced by VEGF. Result:Compared with the control group, model group obviously promoted the proliferation and migration of EA.hy 926 cells(P<0.01). Compared with the model group, cinnamaldehyde (60, 90, 120, 150 μmol·L^-1) significantly suppressed VEGF-induced proliferation and migration of EA.hy 926 cells (P<0.01). Compared with the control group, VEGF group could promote the tube formation of EA.hy 926 cells. The number of nodes, junctions, meshes and vascular branches were increased, but with no statistical difference. Compared with the model group, cinnamaldehyde (90, 150 μmol·L^-1) showed an obvious inhibitory effect on the number of nodes, junctions and meshes of tubules (P<0.05, P<0.01).Compared with the control group, the expressions of p-JAK2, p-STAT3, and STAT3 in the model group were significantly increased (P<0.05, P<0.01). Compared with the model group, Cinnamaldehyde (150 μmol·L^-1) significantly reduced the expressions of P-JAK2, P-STAT3, STAT3 proteins (P<0.01). Cinnamaldehyde (90 μmol·L^-1) obviously reduced the expressions of p-STAT3 and STAT3 proteins (P<0.05, P<0.01). Conclusion:Cinnamaldehyde showed a significantly inhibitory effect on the proliferation, migration and tube formation of VEGF-induced EA.hy 926 cells, which was related to the inhibition of the activation of JAK2/STAT3 pathway.

Objective: To compare the results of invasive dual mitral and aortic valve replacement(DVR) through anterolateral minithoracotomy(RT) and partial upper hemistemotomy(PS) approaches. Methods: This was a retrospective, observational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 10 male and 20 female patients, aging from 15 to 65 years with a mean age of(45.67±12.25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23.0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Association class, perioperative complications, total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups. Results: Both groups successfully completed minimally invasive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT group had longer aortic cross clamp time[(109.00±27.80)min vs.(81.23±14.10)min, P=0.026], cardiopulmonary bypass duration[(152.13±27.15)min vs.(129.55±26.36)min, P=0.049]and total operative duration[(4.81±0.77)h vs.(4.15±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group were shorter than PS group[(24.63±11.55)h vs.(30.55±13.21)h; (5.50±0.93)day vs.(6.59±3.88)day] but there were no statistically significant(P=0.273; P=0.442). Conclusion Minimally invasive dual mitral and aortic valve replacement via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retaining sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of the surgeon. It is more suitable for the heart center that proposed to launch the minimally invasive dual mitral and aortic valve replacement.