Objective This study aimed to explore the regulatory role of autophagy in acute kidney injury(AKI)-induced acute liver injury(ALI).Methods Forty-eight male Sprague-Dawley rats were randomly divided into four groups:sham operation group,IRI group,3-MA group and RA group.Except for the sham operation group,a rat model of AKI induced by IRI was established in all groups.The AKI model was established by removing the right kidney,separating the left renal artery,and clamping the left renal artery,followed by reper-fusion for 12,24,48,or 72 h.The 3-MA and RA groups were intraperitoneally injected with 3-MA(15 mg/kg,1 mL)or RA(2 mg/kg,1 mL)12 h before and after IRI treatment.The structure and function of the rat lung and kidney tissues were evaluated,and the expression levels of autophagy-related proteins,oxidative stress,and apoptosis were measured.Results Renal IRI led to ALI after AKI,and the levels of blood urea nitrogen,creatinine,tumor necrosis factor-α,and interleukin-1βwere all significantly increased.In addition,compared to the IRI group,the expression levels of P62 and caspase-3 significantly decreased in the RA group,whereas the expression levels of LC3-Ⅱ/LC3-Ⅰ,Beclin-1,Bcl-2,and ULK1 increased.Autophagy reduced pathological damage to kidney and lung tissues by inhibiting inflammation and oxidative stress and effectively ameliorated AKI-induced ALI.Conclusion Autophagy plays an important role in the regulation of ALI induced by AKI and can be used as a new target for AKI treatment and to reduce complication-related mortality.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

BACKGROUND: Sweat secreted by eccrine sweat glands is transported to the skin surface through the lumen. The eccrine sweat gland develops from the initial solid bud to the final gland structure with a lumen, but how the lumen is formed and the mechanism of lumen formation have not yet been fully elucidated. This study aimed to investigate the mechanism of lumen formation of eccrine gland organoids (EGOs). METHODS: Human eccrine sweat glands were isolated from the skin for tissue culture, and the primary cultured cells were collected and cultured in Matrigel for 14 days in vitro. EGOs at different development days were collected for hematoxylin and eosin (H&E) staining to observe morphological changes and for immunofluorescence staining of proliferation marker Ki67, cellular motility marker filamentous actin (F-actin), and autophagy marker LC3B. Western blotting was used to detect the expression of Ki67, F-actin, and LC3B. Moreover, apoptosis was detected using a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) apoptosis assay kit, and the expression of poly (ADP-ribose) polymerase and Caspase-3 was detected by Western blot. In addition, 3-methyladenine (3MA) was used as an autophagy inhibitor to detect whether the formation of sweat glands can be effectively inhibited. RESULTS: The results showed that a single gland cell proliferated rapidly and formed EGOs on day 4. The earliest lumen formation was observed on day 6. From day 8 to day 14, the rate of lumen formation in EGOs increased significantly. The immunofluorescence and Western blot analyses showed that the expression of Ki67 gradually decreased with the increase in days, while the F-actin expression level did not change. Notably, the expression of autophagy marker LC3B was detected in the interior cells of EGOs as the apoptosis signal of EGOs was negative. Compared with the control group, the autophagy inhibitor 3MA can effectively limit the formation rate of the lumen and reduce the inner diameter of EGOs. CONCLUSION Using our model of eccrine gland 3D-reconstruction in Matrigel, we determined that autophagy rather than apoptosis plays a role in the lumen formation of EGOs.
Apoptosis ; Autophagy ; Eccrine Glands ; Epithelial Cells ; Humans ; Organoids

Objective To investigate the correlation between the incidence of thyroid carcinoma and TSH, and to provide evidence for clinical application.MethodsSelect 450 cases of patients with thyroid from August 2014 to August 2016 in our hospital as the object of study in this group, the analysis of gender and age of patients, lymph nodes, tumor, laboratory examination results, to explore the relationship between TSH levels and thyroid cancer.ResultsThyroid patients with TSH was significantly higher than that in benign tumor group (P<0.05);the level of TSH and patients with lesion diameter, tumor stage, lymph node metastasis and capsule invasion was significantly correlated (P<0.05), but the level of TSH and age, gender, tumor number, vascular invasion and no significant correlation;TSH the level of thyroid cancer patients were significantly increased (P<0.05).ConclusionThe level of TSH in serum is closely related to the occurrence and development of thyroid cancer, and is closely related to lymph node metastasis and tumor stage, and the higher TSH level can increase the risk of thyroid cancer.

ObjectiveToinvestigatethecorrelationofobstructivesleepapnea(OSAS)andsilentbrain infarction (SBI) in elderly population. Methods A total of 1658 old subjects aged 60 in Beijing and Qingdao w ere screened. Polysomnography (PSG) w as used to conduct the diagnosis and grade of OSAS. MRI w as used to diagnose SBI. Results In al elderly subjects, the prevalences of OSAS and SBI w ere 32.1% and 22.4%. There w ere significant differences in the constituent ratio of the patients w ith hypertension and diabetes, as w el as apnea-hypopnea index (AHI), oxygen desaturation index (ODI), mean oxygen saturation and the low est oxygen saturation betw een the patients w ith OSAS of different severity and the control group. With the increased severity of OSAS, the incidence of SBI increased significantly. The incidences of patients w ith non-OSAS and mild, moderate and severe patients w ith OSAS w ere 13.2%, 30.5%, 43.5%, and 68.8%, respectively. There w as a significant difference betw een the 2 groups ( χ2 =13.365, P=0.004). Multivariable logistic regression analysis showed that hypertension (odds ratio [OR] 2.254, 95%confidence interval [CI] 1.325 to 8.347;P=0.002), diabetes melitus (OR 1.893, 95%CI1.471-8.432;P=0.003) and AHI ≥15 times/h (OR 3.106, 95%CI 1.583-12.571; P<0.001) were the independent risk factors for SBI in elderly population. Conclusions The incidence of OSAS w as higher in the elderly population aged over 60. The incidence of SBI in patients w ith OSAS w as significantly higher than that in patients w ith non-OSAS, and w ith the aggravation of OSAS, it show ed an increasing trend. Moderate to severe OSAS w as an independent risk factor for SBI in elderly population.

OBJECTIVETo explore the mechanism of paraquat (PQ) poisoning and to observe the changes in inflammatory cytokines in PQ-exposed rats treated in different ways.

METHODSFifty 8-week-old clean male Wistar rats were randomly divided into high-dose curcumin plus conventional treatment group, low-dose curcumin plus conventional treatment group, high-dose curcumin group, PQ poisoning group, and blank control group. On days 1, 3, 5, 7, 14, and 21 after PQ exposure, serum levels of transforming growth factor-β₁(TGF-β₁) , tumor necrosis factor-α (TNF-α) , and interleukin-6 (IL-6) were measured. The pathological changes in lung tissue were evaluated by HE staining.

RESULTSCompared with the blank control group, the high-dose curcumin plus conventional treatment group, low-dose curcumin plus conventional treatment group, high-dose curcumin group, and PQ poisoning group had significantly increased serum levels of TGF-β₁, TNF-α, and IL-6 (P<0.05) , and the three cytokines in each group reached peak levels on day 14 after exposure. Compared with the PQ poisoning group, the high-dose curcumin group had significantly reduced serum levels of TGF-β₁, TNF-α, and IL-6 (P<0.05). On day 21 after exposure, there were no significant differences in serum levels of TGF-β₁, TNF-α, and IL-6 between the high-dose curcumin plus conventional treatment group and the low-dose curcumin plus conventional treatment group (P>0.05). The HE staining revealed alveolar inflammatory changes on days 1~7 and massive pulmonary fibrosis on days 14~21 in the high-dose curcumin plus conventional treatment group, low-dose curcumin plus conventional treatment group, high-dose curcumin group, and PQ poisoning group, but the above changes were milder in the high-dose curcumin group than in the PQ poisoning group.

CONCLUSIONFor rats with PQ poisoning, curcumin can significantly reduce inflammatory response and pathological changes in lung tissue and inhibit and delay the development and progression of body injury.

Animals ; Curcumin ; pharmacology ; Cytokines ; blood ; Interleukin-6 ; blood ; Lung ; pathology ; Male ; Paraquat ; poisoning ; Pulmonary Fibrosis ; pathology ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Transforming Growth Factor beta1 ; blood ; Tumor Necrosis Factor-alpha ; blood

Objective To observe and analyze the change and the influence factors of the immune function of the neonates with hypoxic ischemic encephalopathy ( HIE) .Methods 60 patients with HIE were selected as the observation group,and 60 healthy neonates were selected as the control group.The CD1+9 ,CD1+9 CD2+5 B lymphocyte per-centages,IgG,IgM,IgA,complement C3,C4 levels in peripheral blood of the neonates in the two groups were detected and analyzed.At the same time, the Apgar scores, placenta condition, amniotic fluid contamination degrees,the modes of delivery,modes of feeding of the neonates in the two groups were observed and compared.Results The percentages of CD1+9 lymphocytes or CD1+9 CD2+5 lymphocytes,IgM,IgA,C3,C4 levels of the neonates in the control group were significantly higher than those of the observation group ( t=3.586,4.158,3.262,3.457,3.056,5.163, all P<0.05);the percentages of CD1+9 lymphocytes or CD1+9 CD2+5 lymphocytes,IgM,IgA,C3,C4 levels of the severe HIE patients were significantly lower than those of the moderate HIE patients or the mild HIE patients ( t=3.285, 4.752,5.113,3.748,4.287,3.953,4.116,5.201,6.284,3.416,5.314,3.928,4.063,6.026,all P<0.05) and the IgA and C4 levels of the moderate HIE patients were significantly lower than that of the mild HIE patients ( t=3.452,3.281,all P<0.05);the percentage of CD1+9 ,IgA,C4 levels of the neonates with HIE were positively cor-related with Apgar score ( r=0.768,0.026,0.016,all P<0.05) .When the choking symptoms were severer,the im-mune indexes decreased more significantly;the IgG,IgM levels of the neonates with HIE were negatively correlated with the amniotic fluid contamination degrees(r=-0732,-0.025,all P<0.05);the IgA level was positively corre-lated with breastfeeding(r=0.053,P<0.05),and the IgG level was positively correlated with the birth weight(r=0.018,P<0.05).Conclusion The immune function of neonates with HIE significantly decreases and the decline of the immune function may be related with the degree of the disease.The birth condition of the neonates,asphyxia,am-niotic fluid contamination degrees,birth weight,feeding mode are the factors affecting the immune function of the pa-tients.

Objective To explore the advantage of anterior cervical muscle group approach at sternal end transection in removal of bilateral huge thyroid neoplasm.Methods One hundred and seven patient underwent removal of bilateral huge thyroid neoplasm were selected.Fifty-two patients were given neck white line incision thyroid surgery (control group) and 55 patients were given anterior cervical muscle group approach at sternal end transection for thyroid surgery (observation group).The operative time,operation field exposure effect,amount of bleeding in operation,postoperative complications,and postoperative drainage volume were compared between two groups.Results The operative time [(88.53 ± 5.95) min],amount of bleeding [(18.58 ± 5.95) ml],and postoperative drainage volume [(47.58 ± 14.76) rnl] in observation group were less than those in control group [(113.98 ± 15.85) min,(39.27 ± 16.32) ml,(73.90 ± 14.40) ml] (P ＜ 0.05),the postoperative complication rate was lower than that in control group (P ＜ 0.05).Operation field exposure effect in observation group was better than that in control group (P ＜ 0.05).Conclusions Removal of bilateral huge thyroid neoplasm with the sternal end approach is feasible and simple.The operation field exposure is better than the neck white line incision,complications after operation is less.It is worthy of clinical application.

In medical physiology experiment courses, the students observe the functions and learn the rules of biological body, in order to improve their abilities of scientific observation, practice and reflection. Emotion control means willpower to manage emotion, which is the regular psychological response when we deal with issues. Integrating the emotion control education to professional education is imperative to elevate the general quality of medical students.

A device for promoting normal locomotor activity recuperation was made, which was composed by frame, elastic bolt and normal gait mark carpet. The device has the effects of weight relieving, abnormal gait preventing, and safeguards providing. The patient could do gait training by he/her self or assistant self training under the weight reducing and protecting of the device in order to improve the walking ability and the normal gait formation. It is effective for preventing drop foot and leg adduction, and also helpful for the recovery of normal gait ability and the prevention of abnormal gait formation. It is applicable for the patient who can not be trained with ordinary weight relief walking training, such as severe cerebral palsy and severe spasmodic lower extremity and foot drop after brain injury. The results demonstrated that the device is effective in protecting, correcting, preventing abnormal gait as well as forming normal gait.