Objective To explore the protective role of DNA damage induced transcription factor 4(DDIT4)in oxidative stress injury in dermal papilla cells and its underlying mechanisms.Methods Dermal papilla cells were exposed to UVA and H2O2 to establish cellular model of oxidative stress.CCK-8 assay was used to detect cell viability under different treatment conditions,and the production of intracellular reactive oxygen species(ROS)was detected using 2',7'-dichlorofluorescein diacetate(DCFH-DA).Autophagic vesicles were observed with electron microscopy.Western blotting was employed to measure the expression of DDIT4 and autophagy-related molecules,including microtubule-associated protein 1 light chain 3(LC3),ubiquitin-binding protein(P62),mammalian target of rapamycin(mTOR),and p-mTOR.Results UVA and H2O2 resulted in more production of ROS(P＜0.05)and decreased viability of dermal papilla cells(P＜0.05).DDIT4 expression was increased in dermal papilla cells under oxidative stress(P＜0.05),and the antioxidant N-acetyl-L-cysteine(NAC)could effectively inhibit this effect(P＜0.05).After treatment with UVA or H2O2,cell autophagy was enhanced in dermal papilla cells,characterized by an increase in the number of autophagosomes and an increased LC3 Ⅱ/Ⅰ ratio(P＜0.05),a decrease in P62 expression(P＜0.05),and 3-methyladenine(3-MA)blocking autophagy led to further reduced cell viability(P＜0.05)and increased intracellular ROS production(P＜0.05).Conversely,rapamycin(RAPA)increased autophagy level and improved the viability of dermal papilla cells under oxidative conditions(P＜0.05),and reduced the generation of intracellular ROS(P＜0.05).Additionally,down-regulation of DDIT4 weakened autophagy in dermal papilla cells under oxidative stress,reduced LC3 Ⅱ/Ⅰ(P＜0.05),increased p-mTOR/mTOR and P62(P＜0.05),inhibited cell viability(P＜0.05),and enhanced intracellular ROS production(P＜0.05).Conclusion DDIT4 may alleviate oxidative stress injury in dermal papilla cells through autophagy.

Objective:To explore the efficacy of doctor-nurse co-led care involving education and engagement of patients on improving compliance of patients, and a treat-to-target urate-lowering rate for gout.Methods:Nurses were trained in practice management of gout. Patients diagnosed with gout in the departments of rheumatology and immunology of Anqing Municipal Hospital in Anhui Province were prospectively enrolled from January 1 to June 30, 2019. The patients were divided into the continuous-care group and the conventional management group by random number table method. The patients of continuous-care group received telephone follow-up, WeChat tracking and regular face-to-face communication. The patients of conventional management group were told to follow up regularly in the outpatient department, and the nurses did not follow up. Patients were evaluated before intervention and 12 months after intervention. The treat-to-target rate of blood uric acid and the frequency of gout flares were observed.Results:After 12 months of intervention, the patients of serum uric acid concentrations below 360 μmol/L were 92.39% (85/92) in the continuous-care group, and 26.74% (23/86) in the conventional management group. There was significant difference ( χ2 value was 80.282, P<0.001). After 12 months of intervention, the average serum uric acid concentration of patients in the continuous-care group was (301.6±61.4) μmol/L, and that in the conventional management group was (419.0±98.0) μmol/L, both of which were significantly lower than before intervention, continuous-care group (466.1±119.7) μmol/L, conventional management group (477.8±113.1) μmol/L. But the average serum uric acid concentration of patients in the continuous-care group was significantly lower than that in the conventional management group. There was significant difference between them ( t value was 96.678, P<0.001). At the end of 12 months, the patients of uric-acid-lowering therapy increased in both groups. The proportion of patients was 94.56% (87/92) in the continuous-care group, which was significantly higher than that in the conventional management group (58.14%, 50/86), there was significant difference ( χ2 value was 33.260, P<0.001). Conclusions:The mode of continuing nursing combined with specialized physician-led treatment can significantly improve the compliance and the control rate of treat-to-target for gout, and this management method is simple and feasible which provides a new management concept for clinical treatment of gout.

OBJECTIVE：To ex plore the protective effects of Longbie capsule contained serum （called“LBJN”for short ）on the apoptosis of chondrocytes induced by YAP inhibitor verteporfin and its mechanism. METHODS ：Primary human knee osteoarthritis（OA）chondrocytes were extracted by two-step enzymatic digestion ，and then identif ied by toluidine blue staining and type Ⅱ collagen immunofluorescence staining. The effects of 2，5 μmol/L verteporfin alone or combined with 5％LBJN on cell apoptosis were detected by flow cytometry. Solvent control （0.1％ DMSO）and 5％ LBJN were set. Western blot assay was adopted to detect the expression of apoptosis related proteins （YAP，Bcl-2，cleaved-caspase-3） after treated with 0.1％DMSO（solvent control ），2 μmol/L verteporfin，2 μmol/L verteporfin+5％LBJN 和 0（blank control ），2.5％ LBJN and 5％ LBJN for 48 h. The expression of autophagy related proteins （mTOR，Beclin-1，LC3A/B） after treated with 0 （blank control ），2.5％，5％ LBJN for 48 h were det ected by Western blot assay. RESULTS ：The isolated cells accorded with the characteristics of chondrocytes. Compared with 0.1％DMSO， the apoptosis rates of cells were increased significantly after treated with 2，5 μmol/L verteporfin（P＜0.05），and the effects of the two concentrations were similar （P＞0.05）. Compared with verteporfin alone ，2，5 μmol/L verteporfin combined with 5％LBJN could significantly decrease the apoptotic rate of cells （P＜0.05）. Compared with 0.1％DMSO，the protein expression of YAP and Bcl-2 were decreased significantly after treated with 2 μ mol/L verteporfin （P＜0.05）， while the protein expression of cleaved-caspase-3 were increased significantly （P＜0.05）. Compared with 2 μmol/L verteporfin，protein expression of YAP and Bcl-2 were increased significantly after treated with 2 μmol/L verteporfin+5％LBJN（P＜0.05），while the protein expression of cleaved-caspase-3 were decreased significantly （P＜0.05）. Compared with blank control ，the protein expression of YAP ，Bcl-2 and Beclin-1 were increased significantly after treated with 2.5％，5％LBJN（P＜0.05），while protein expression of cleaved-caspase- 3 and mTOR were decreased significantly （P＜0.05）. CONCLUSIONS ：LBJN can block the apoptosis of chondrocytes induced by YAP inhibitor verteporfin ，and its mechanism may be related to regulating the expression of apoptosis related proteins and enhancing autophagy of chondrocytes.

OBJECTIVE： To study the effects of ligustrazine on miR-20b/VEGF and BMP2/Smad1 pathways in subchondral bone of knee osteoarthritis （KOA） model rats， and to investigate the mechanism of ligustrazine for KOA prevention and treatment. METHODS： Totally 18 healthy male SD rats were randomly divided into normal control group， model group and ligustrazine group， with 6 rats in each group. The rats in the latter two groups were used to establish KOA model by intra-articular injection of 4％ papain solution. From the 2nd day after the last injection， ligustrazine group was given intragastrical administration of Ligustrazine suspension （100 mg/kg） 2 mL； normal control group and model group were given intragastrical administration of isometrical normal saline， once a day， for consecutive 6 weeks. After the last after medication， the situation of bilateral knee articular cartilage of rats were observed after exposure. The knee joints of rats were sectioned and stained with HE. The pathological change of articular cartilage were observed by microscope and scored by modified Mankin’s score. mRNA expression of VEGF， BMP2 and Smad1， and the expression of miR-20b were detected by RT-PCR； the protein expression of VEGF， BMP2 and Smad1 were detected by Western blot assay. RESULTS： Model group and ligustrazine group suffered from cartilage injury of knee joint at varying degrees. Compared with normal control group， Mankin’s scores of knee joint and cartilage tissue were increased significantly in model group （P＜0.01）； mRNA and protein expression of BMP and Smad1， the expression of miR-20b in subchondral bone of model group were decreased significantly， while mRNA and protein expression of VEGF were increased significantly （P＜0.01）. Compared with model group， Mankin’s score of cartilage tissue were decreased significantly in ligustrazine group （P＜0.01）； mRNA and protein expression of BMP and Smad1， the expression of miR-20b in subchondral bone were increased significantly， while mRNA and protein expression of VEGF were decreased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS： Ligustrazine can repair damaged articular cartilage in KOA model rats， the mechanism of which may be associated with inhibiting the protein expression of VEGF and activating BMP-2/Smad1 signaling pathway via up-regulating the expression of miR-20b， and promoting the degradation of VEGF mRNA in subchondral bone.

Objective: To investigate the prevalence of metabolic disorder among the high school students in Guangzhou. Methods: A cross-sectional study among 4 620 high school students selected with stratified cluster sampling was conducted in Guangzhou. Height, weight, blood pressure, fasting plasma glucose (FPG) and serum lipid of TC, TG were measured. Household socioeconomic status, medical history, physical activities as well as personal diet and study habits were acquired with structured questionnaire. Results: The prevalence of central obesity was 11.5%. The overall prevalence of IFG and DM was 6.9%. The overall prevalence of both hypercholesteremia and hypertriglyceridemia was 13.4%. The prevalence of hypertension was 11.6%. With multivariable logistic regression, the results showed that: fast eating was associated with increased risk of central obesity (OR=1.79, 95%CI=1.47-2.18) and hypercholesteremia/hypertriglyceridemia (OR=1.27，95%CI=1.04-1.54). While students who ate slow had low risk of central obesity (OR=0.47, 95%CI=0.33-0.68), hypercholesteremia/hypertriglyceridemia(OR=0.71, 95%CI=0.54-0.94) and hypertension (OR=0.65, 95%CI=0.49-0.88). Students with sugar-sweetened beverages once a day or more had higher risk of central obesity (OR=1.60, 95%CI=1.08-2.38) while students without sugar-sweetened beverages consumption had low risk of IFG/DM (OR=0.57, 95%CI= 0.43-0.77) than those who consumed 1-2 times/week. Students without eating out habit had lower risk of hypercholesteremia /hypertriglyceridemia than those with eating out for 1-2 times/week (OR=0.78, 95%CI=0.62-0.98), and students who had lunch out of home or canteen had higher risk of hypercholesteremia /hypertriglyceridemia than those who ate at canteen (OR=1.38，95%CI=1.06-1.81). Conclusion The prevalence of metabolic disorder among high school students in Guangzhou is at a relatively high level. High eating speed, heavy sugared beverages intake and frequently eating out habits are associated with risk of metabolic disorder.

Objective To evaluate the efficacy of acetate Ringer's solution for fluid therapy in the patients with dangerous placenta previa undergoing cesarean section. Methods One hundred fifty-two pa-tients, aged 22-41 yr, with body mass index of 20-30 kg/m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective cesarean section under general anesthesia, were allocated to 2 groups ( n=76 each) using a random number table method: acetate Ringer's solution group ( group AR) and lactated Ringer's solution group ( group LR) . Acetate Ringer's solution and lactated Ringer's so-lution 500 ml were intravenously infused at an initial rate of 15 ml·kg-1 ·h-1 followed by an infusion of 10 ml·kg-1·h-1 until patients leaved the operating room in two groups. Blood samples were collected from the left radial artery immediately before fluid replacement, at the end of fluid replacement and at 6 h after sur-gery for blood gas analysis. The development of arrhythmia was recorded during fluid replacement. The postpartum hemorrhage at 2 h after surgery was calculated. Results Compared with group LR, the Mg2+level was significantly increased and blood glucose was decreased at the end of fluid replacement, the inci-dence of arrhythmia was decreased ( P ＜ 0. 05) , and no significant change was found in each parameter of blood gas analysis at 6 h after surgery, postpartum hemorrhage at 2 h after surgery or consumption of ephed-rine in group AR ( P＞0. 05) . Conclusion Acetate Ringer's solution can be effectively used for fluid ther-apy, maintain the internal environment stable and prevent the occurrence of arrhythmia effectively during cesarean section in the patients with dangerous placenta previa.

Objective To study the clinical efficiency and adverse reactions of simultaneous modulated accelerated radiotherapy (SMART)and intensity-modulated radiation therapy (IMRT)in advanced cervical cancer. Methods Sixty patients with advanced cervical cancer were collected from April 2011 to April 2017 in our hospital. The 60 patients were randomly divided into experimental group (30 cases)and control group (30 cases)by using stratified randomization method. The two groups were given intracavitary irradiation and concur-rent chemotherapy. The patients in experimental group were treated with SMART and the patients in control group were treated with IMRT. 95％ planned target volume was 50. 4 Gy/ 28 F in the two groups and the dose for IMRT with simultaneous integrated boost was 64. 4 Gy/ 28 F to the planning target volume. Disease progres-sion,survival time and adverse reactions of the two groups were compared. Results At the end of radiothe-rapy,the experimental group had 23 patients with complete response (CR),4 patients with partial response (PR),2 patients with unaltered stable disease (SD),1 patient with progressive disease (PD),and the control group had 22 patients with CR,3 patients with PR,3 patients with SD,2 patients with PD. The overall effi-ciency of the experimental group was slightly higher than that of the control group (90. 0％ vs. 83. 3％),but the difference was not statistically significant (χ2 = 0. 144,P = 0. 704). After 3 months of radiotherapy,the experimental group had 28 patients with CR,1 patient with PR,1 patient with PD,and the control group had 22 patients with CR,2 patients with PR,3 patients with SD,3 patients with PD. The overall efficiency of the experimental group (96. 7％)was higher than that of the control group (96. 7％ vs. 80. 0％),but the diffe-rence was not statistically significant (χ2 = 2. 588,P = 0. 108). The median overall survival time of the experi-mental group and control group were 43 months and 38 months,and the difference was statistically significant (χ2 = 7. 087,P = 0. 008). The 1-year survival rates of the two groups were 96. 6％ and 85. 7％,and the 3-year survival rates were 86. 2％ and 60. 7％,respectively. There were no significant differences in the inci-dences of gastrointestinal reaction (66. 7％ vs. 63. 3％,χ2 = 0. 073,P = 0. 787),urinary system reaction (33. 3％ vs. 30. 0％,χ2 = 0. 077,P = 0. 781)and bone marrow suppression (83. 3％ vs. 86. 7％,χ2 =0. 000,P = 1. 000)between the two groups. Conclusion The efficiency of advanced cervical cancer patient treated with SMART is better than IMRT,and the adverse reactions are tolerable,which is worthy of clinical promotion.

Objective To compare the differences in the long-term survival rate and the tumor shrinkage rate of inoperable hepatocellular carcinoma (HCC) between transcatheter arterial chemoembolization (TACE) combined with percutaneous ablation therapy and simple TACE therapy in order to provide the basis for the clinical treatment of HCC.Methods Randomized controlled trials (RCT) for comparing the difference in survival rates between TACE plus PA and simple TACE for inoperable HCC were searched from medical literature database,from which the relevant data were extracted.According to Cochrane manual standard,the quality of inclusion literature was evaluated.Results A total of 15 RCT papers were included in this study,including 859 HCC patients.The results of meta-analysis showed that all the 1-year,2-year and 3-year survival rates in TACE plus PA group were better than those in simple TACE group (RR=1.454,95％CI=1.333and 1.586,Z=8.56,P＜0.001;RR=1.781,95％CI=1.511 and 2.099,Z=6.88,P＜0.001;RR=2.351,95％CI=1.808 and 3.059,Z=6.37,P＜0.001,respectively).The tumor shrinkage rate in TACE plus PA group was also better than that in simple TACE group (RR=1.314,95％CI=1.190 and 1.452,Z=5.38,P＜0.001).The sensitivity analysis indicated that the results of the differences in survival rate and tumor shrinkage rate between the two groups were reliable.Conclusion The 1-year,2-year and 3-year survival rates as well as the tumor shrinkage rate of TACE plus PA group are higher than those of simple TACE group.

Objective To investigate the influencing conditions of human epidermal stem cells(ESCs) differentiating into gland-like cells and to identify the induced tubular structure.Methods The ESCs were seeded onto compound polysaccharide shell dermal matrix and collagen gel,adding different concentrations of epidermal growth factor(EGF) and culturing by vertical shaking in vitro,the three dimensional culture and induced directional differentiation were performed.The means of HE staining,immunofluorescence and confocal laser scanning microscope were adopted to observe the conditions,morphology and phenotype change of ESCs directionally differentiating into glandular epithelium-like cells.Results 15-20 ng/mL EGF could induce ESCs in tissue-engineering dermis to grow into dermis and appear the gland-like structure.The HE staining in this structure showed its profile as a single layer with lacune in the middle compartment,eosinophilic cytoplasm,lightly stained.Under CLSM,by CK19 staining,the luminal structure in the middle of the cell mass was observed,while CK18 and CEA were expressed in this structure.Conclusion Under the induction of particular concentration of EGF,the in vitro cultured human ESCs seeded on the tissues engineering dermis could form into the tubular structure,which is similar to the in vivo sweat gland secretory cells in morphology and histology.

Objective To evaluate the efficacy and safety of Tanreqing injection in the treatment of elder chronic senile obstructive pulmonary disease.Methods 78 cases of chronic senile obstructive pulmonary disease patients from August 2014 to May 2015 in our hospitol were selected and divided into control group and experiment group,with 39 cases in each group.The patients in the both groups were give regular treatment,patients in the control group were given theophylline sustained release tablets 0.2 g oral,two times a day;The experiment group were treated on base of the control group were given Tanreqing injection 20mL+5％intravenous glucose injection 500mL.The clinical efficacy,type B brain natriuretic peptide(BNP),calcitonin(PCT),forced vital capacity(FVC),forced expiratory volume in one second(FEV1),forced vital capacity(FVC)/expected value,and adverse reactions were compared between the two groups.Results The clinical efficacy in experiment group was 94.87％,which significant higher than that in control group(82.05％,P<0.05).The level of BNP serum PCT in two groups after treatment were significantly decreased,and the experiment group was significantly lower than the control group(P< 0.05);FEV1/expected,value FEV1/FVC levels were significantly increased and the experiment group was significantly higher than that of the control group(P< 0.05).The adverse drug reactions was not statistically different between the two groups.Conclusion Tanreqing injection in the treatment of elder chronic senile obstructive pulmonary disease with significant clinical efficacy,and with high safety.