ObjectiveStudies have shown that nuciferine has anti-cerebral ischemia effect， but the specific mechanism of action has not been elaborated. Based on the transcriptome results， the pharmacological mechanism of nuciferine against cerebral ischemia was analyzed from multiple dimensions including tissue， cell， pathological process， biological process and signaling pathway. MethodsThirty SD rats were randomly divided into the sham group， model group and nuciferine group（40 mg·kg^-1） according to weight. Except for the sham group， the model of middle cerebral artery occlusion（MCAO） was established by thread embolization method after 30 min of administration in the other two groups. Twenty-four hours after surgery， transcriptome sequencing was used to detect the gene expression profiles in the cortex penumbra of rat cerebral tissue， and gene ontology（GO） and kyoto encyclopedia of genes and genomes（KEGG） pathway enrichment analysis were performed for differentially expressed genes. The mechanismof nuciferine against cerebral ischemia was analyzed from 5 dimensions of tissue， cell， pathological process， biological process and signaling pathway by the transcriptome-based multi-scale network pharmacology platform（TMNP）. ResultsTranscriptome sequencing and gene quantitative analysis showed that 667 genes were significantly reversed by nuciferine. Further enrichment analysis of KEGG and GO suggested that the pathways of nuciferine involved regulating stress response， ion transport， cell proliferation and differentiation， and synaptic function. TMNP research found that at the tissue level， nuciferine could significantly improve the cerebral tissue injury caused by ischemia. At the cellular and pathological levels， nuciferine could play an anti-cerebral ischemia role by improving the state of various nerve cells， mobilizing immune cells， regulating inflammation. And at the level of biological processes and signaling pathways， nuciferine mainly acted on the processes such as vascular remodeling， inflammation-related signaling pathways， and synaptic signaling. ConclusionCombined with the results of transcriptome sequencing， gene quantitative analysis and TMNP， the mechanism of nuciferine against cerebral ischemia may be related to processes such as intervening in stress response and inflammation， affecting vascular remodeling and regulating synaptic function. These results can provide a basis and reference for further study of the pharmacological mechanism of nuciferine against cerebral ischemia.

Objective:To analyze the clinicopathological features and prognostic factors of alpha‐fetoprotein‐producing gastric carcinoma (AFPGC).Methods:A retrospective analysis was made on 2 671 GC patients admitted from Jan 1998 to Dec 2018 , AFPGC patients and matching AFP negative GC cases were enrolled and their clinicopathological features and prognostic factors were analyzed. The survival curve was drawn by Kaplan-Meier method. Log-rank test was used to test the significance, Univariate analysis was performed by using COX proportional hazard model.Results:There were 98 AFPGC in this study accounting for 4.5% of all GC of the corresponding time period. The proportion of male to female was 2.16∶1, the average age was (65±12) years. The serum AFP levels significantly decreased after operation in most patients (median: 52 ng/ml vs. 5 ng/ml, Ｚ=-2.736, P=0.001). Serum AFP and CEA levels in patients with AFPGC before treatment were significantly higher than that in patients with AFP negative GC (both P<0.05) . Vascular invasion(62.71% vs. 40.68%) and liver metastasis (31.63% vs .6.12%) were more likely to occur in AFPGC groups (both P<0.05). However, there was no significant difference between the two groups in tumor size, location, differentiation and lymph node metastasis (all P>0.05). The prognosis of AFPGC was significant pooer than that in AFP negative GC ( P<0.05). Prognosis of AFPGC patients was significantly correlated with preoperative serum AFP level, TNM stage, lymph node metastasis, simultaneous liver metastasis and vascular invasion (all P<0.05) . COX multivariate survival analysis found that preoperative serum AFP level was independent risk factors of patients with AFPGC ( P<0.05). Conclusion:AFPGC is a special GC charactering poor prognosis .

Objective:To study the relation ship between the branch patterns of inferior mesenteric artery (IMA) and imaging pelvic measurement parameters for anastomotic leakage (AL) after anterior resection (AR) of rectal cancer.Methods:Five hundred thirty-four patient were enrolled from Jan 2008 to Dec 2018 at the General Surgery Department of Guizhou Provincial People's Hospital. The AL related imaging risk factors were analyzed by chi-square test or Fisher's exact test.Results:AL was found in 36 (6.7%) patients. AL related mortality rate was 11.1% (4/36) compared to 0.4% (2/498) in those without the complications of no AL cases ( P<0.001). Seven pelvic imaging measurement results were attained in 412 patients including anteroposterior diameter of the inlet of the pelvis, anteroposterior diameter of the outlet of the pelvis, upper edge of the symphysis pubis to the tip of the coccyx, sacrococcygeal distance angle from the lower edge of the pubis to the upper edge of the pubis to the sacral promontory, distance between the ischial spines and that of ischial tuberosity. Univariate analysis showed that there was no significant relationship between the above 7 pelvic measurement parameters and the occurrence of AL (all P>0.05). There was no significant relationship between branch patterns of IMA and AL after rectal cancer surgery ( P=0.712). Conclusion:AL as a severe postoperative complication in rectal cancer patients undergoing AR procedure were caused by multiple factors. Neither IMA branch patters nor pelvic imaging measurement seem to be related to the occurrence of AL after AR for rectal cancer.

Objective:To evaluate the effect of Kinesio taping on knee osteoarthritis (KOA). Methods:The Cochrane Library, PubMed, CNKI, Web of Science and PEDro were searched from inception to November, 2018. The randomized controlled trials (RCTs) about the effect of Kinesio taping on knee osteoarthritis were collected. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Meta-analysis was performed using RevMan 5.3. Results:A total of six RCTs were enrolled. There were significant differences in the scores of Visual Analogue Score between the intervention group and the control group (WMD = -1.28, 95%CI -2.36 to -0.20, P = 0.02). There were no significant differences in Western Ontario and McMaster Universities Osteoarthritis Index, range of motion, quadriceps femoris and hamstring muscle strength between the intervention group and the control group (P > 0.05). The other studies only adopted descriptive analysis accordingly. Conclusion:It is still uncertain in the effectiveness of Kinesio taping on knee osteoarthritis.

Objective To study the predictive value of magnetic resonance imaging (MRI),positron emission computed tomography (PET)and PET/MRI coregistration in intractable epilepsy of children.Methods A retrospec-tively analysis was performed based on the surgery data at the Department of Children Epilepsy Center of Peking Univer-sity First Hospital from September 2015 to March 2016.The clinical data,surgery and follow－up study data,interictal and ictal electroencephalogram,MRI,PET and PET/MRI coregistration data were collected.By comparison with the epi-leptogenic zone designed by pre－surgical workup,the accuracy of MRI,PET and PET/MRI coregistration in detecting lesion was assessed.In the patients who had no seizure during≥1 year follow－up,their sensitivity,specificity,positive predictive value,negative predictive value of MRI,PET and PET/MRI coregistration were calculated.Results (1)A total of 62 patients underwent surgery,30 boys and 32 girls. The average age on epilepsy onset was 2. 50 years (2 days－11.70 years),and average age on surgery was 5.10 years old(0.75－15.60 years old).(2)Surgical treat-ment of 62 cases included the resection of the focal or lobar (32 cases,51.6%),and the multilobar (16 cases, 25. 8%).Hemispherotomy was done in 14 cases (22.6%).During ≥1 year follow－up,seizure outcome was Engel class Ⅰ in 57 cases (91.9%)out of the 62 patients,Engel classⅡto Engel classⅣin 1 case,3 cases,and 1 case, respectively.(3)Referred to epileptogenic zone designed by presurgical workup,MRI represented 64.5%(40/62 ca-ses)results with accordance,PET and PET/MRI coregistration was 72.5%(45/62 cases)and 85.5%(53/62 cases), respectively,and the difference was significant(χ2＝7.25,P＝0.03).(4)Based on the patients of Engel class Ⅰ, their sensitivity and specificity were 66.7%,60.0% in MRI,75.4%,60.0% in PET %,and 85.9%,80.0% in PET/MRI coregistration,respectively.(5)There were 11 ＂non－lesion＂ cases of all focal cortical dysplasia in patholo-gy,and subtle structural abnormalities were de tected in 9 cases by reviewing MRI.Conclusions PET/MRI coregistra-tion can improve lesion detection of intractable epilepsy in children.

Objective To explore the protective effects of GYY4137, a new hydrogen sulfide donor, on intestinal mucosa in a neonatal rat model of necrotizing enterocolitis (NEC), and its potential mechanism.Methods Sixty SD rats were randomly assigned into 4 groups: group A (control group), group B (NEC group), group C (NEC with GYY4137 treatment, H2S donor group), and group D (NEC with GYY4137 and Znpptreatment, HO-1 inhibitor group). The SD rat models of NEC were established using simulated milk feeding-hypoxia-cold stress-Lipopolysaccharides. The injury degree of intestinal mucosa was evaluated using HE-staining, and its mechanisms were investigated using biochemical indicators and Western blotting. Results Compared with control group, the pathology score and the total superoxide dismutase (T-SOD) in the NEC group was significantly higher, the concentrations of methane dicarboxylic aldehyde (MDA) and necrosis factor α (TNF-α) were lower(P<0.05). Compared with those in NEC group, the pathology score and the concentration of MDA and TNF-α in the H2S donor group were signiflcantly lower, the T-SOD, and the HO-1 expression was higher. The pathology score and the level of MDA and TNF-α were signiflcantly increased after treated with HO-1 inhibitor Znpp, and T-SOD was signiflcantly decreased.. Conclusions The GYY4137, as a new H2S donor, could attenuate the injury of intestinal mucosa in a neonatal rat model of NEC by upregulating the expression of HO-1.

Objective To compare the characteristics of intrahepatic cholangiocarcinoma (ICC) and different differentiated hepatocellular carcinoma (HCC) by CEUS and evaluate the diagnostic value of CEUS.Methods The cases who underwent CEUS and were pathologically demonstrated as ICC (n=34) and HCC (n=136) were observed.The characteristics of ICC and different differentiated HCC in conventional ultrasound and CEUS were analyzed,and the diagnostic efficiency of wash out time were calculated.Results ICC had higher percentage (24/34,70.59％) of washout emerging in early portal phase than those of HCC.And ICC had lower percentage (0;4/34,11.76％) of washout emerging in middle and late portal phase than poorly and moderate differentiated HCC.Poorly differentiated HCCs had higher percentage (16/41,39.02％) of washout emerging in middle portal phase than well differentiated HCC.The sensitivity,specificity,positive predictive value,negative predictive value,accuracy,positive likelihood ratio and negative likelihood ratio of washout time in diagnosis of ICC were 82.35 ％ (28/34),91.18％ (124/136),70.00％ (28/40),95.38％ (124/130),89.41％ (152/170),9.4,0.2,respectively.The rise time of ICC and well,moderate and poorly differentiated HCC were (13.03 ± 3.49) s,(13.80 ± 3.04)s,(14.89±4.12)s,(16.00±3.38)s,respectively,and the difference was significant (F=4.369,P＜0.05).The rise time of ICC was significantly higher than that of well differentiated HCC (P＜0.05).Conclusion The CEUS performances are different significantly among ICCs and different differentiated HCCs,which has value for the differential diagnosis.

Objective To investigate the value of dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) in evaluating therapeutic response of hepatoma treated with radiofrequency ablation (RFA).Methods Totally 48 cases of patients with hepatic carcinoma (48 lesions) admitted in Xiangya Hospital of Central South University from September 2012 to January 2014 were selected.All patients underwent radiofrequency ablation,of which 30 patients were diagnosed by pathology after surgery,18 patients by clinical diagnosis.All patients underwent two-dimensional contrast-enhanced ultrasound (2D-CEUS) and 3D-CEUS 1 month and 3 months after RFA treatment to evaluate the therapeutic response,and the results of contrast-enhanced ultrasound and enhanced computed tomography (CT) [or magnetic resonance imaging (MRI)] were compared.The final diagnostic results of pathologic biopsy or more than two imaging examinations [ultrasonography,CT,MRI,positron emission tomography (PET)],tumor markers,and more than 3 months follow-up of patients were used as the gold standard.The sensitivity,specificity and accuracy of dynamic 3D-CEUS,2D-CEUS,enhanced CT (or MRI) in the diagnosis of tumor inactivation were calculated respectively.Results After radiofrequency ablation,dynamic 3D-CEUS could provide more valuable information in 75.0％ (36/48) lesions,which contribute to assess the efficacy of radiofrequency ablation.While compared with 2D-CEUS,3D-CEUS did not change the diagnosis or clinical management in 12 (25.0％) lesions.40 of 48 lesions were found no-enhancement in entire CEUS procedure suggesting that the tumor completely inactivated,while 8 lesions showed local enhancement on the edge of lesion suggesting that part of the tumors were active.39 of 48 lesions showed no-enhancement and other 9 with irregular enhancement on enhanced CT (or MRI).The sensitivity,specificity and accuracy of CEUS and enhanced CT (or MRI) in detection of residual tumor after radiofrequency ablation were 80.0％,100％,95.8％ and 80.0％,97.4％,93.8％,respectively.Conclusions There was no statistical significance among 3D-CEUS,2D-CEUS and enhanced CT or MRI in evaluating therapeutic response of hepatoma treated with radiofrequency ablation.But 3D-CEUS can provide more valuable information,3D-CEUS has potential usefulness in the evaluation of percutaneous radiofrequency ablation of hepatic tumors.

Objective To introduce a case of ethylmalonic encephalopathy which is an autosomal recessive metabolic disorder caused by mutations in the ETHE1 gene. Methods The clinical course and gene mutation in a case of ethylmalonic encephalopathy was retrospectively analysed. Results A previously healthy girl presented with intractable diarrhea from the age of 7 months. Since then, progressive psychomotor regression has been observed. When she was 23 months, her blood butyr-ylcarnitine was signiifcantly increased (4.48μmol/L vs. normal range 0.0~1.0μmol/L), and isovalerylcarnitine (0.70μmol/L vs. normal range 0.0~0.65μmol/L) was also elevated. Her urine levels of ethylmalonic acid and methylsuccinate acid were markedly increased. Cranial MRI revealed bilateral basal ganglia lesions supporting the diagnosis of ethylmalonic encephalopathy. On her ETHE1 gene, a reported mutation (c.488G>A, p.R163Q) and a novel mutation (c.203T>C, p.L68P) were identiifed. After lactose-free dietary treatment and the supplements of L-carnitine, coenzyme Q10, vitamins B1, B2 and C, gradual improvement in general condition, intelligence and motor development has been observed. Conclusions Ethylmalonic aciduria is common in the patients with inborn errors of mitochondrial fatty acid beta-oxidation. In ethylmalonic encephalopathy, elevated blood levels of butyrylcarnitine and isovalerylcarnitine are common and ETHE1 sequencing is helpful in its diagnosis.

Objective To improve the knowledge of primary gout in children. Methods Clinical data of a 12-year-old girl with primary gout was collected. Analysis of UMOD gene, REN gene and HNF-1βgene was performed using PCR and di-rect sequencing. Results The girl was admitted for 1-month history of left hallux pain accompanied with elevations of serum uric acid concentration and serum creatinine concentration. Several examinations showed serum uric acid/creatinine ratio was greater than 2.5. The fractional excretion of uric acid was 3.4%-6.6%. The X-ray showed that the proximal phalanxes of halluces were erosion. The diagnosis of renal biopsy was ischemic renal injury and chronic tubulointerstitial nephropathy. Blood uric acid concentrations of parents were normal, and the family history of gout was negative. Two single nucleotide polymorphisms (c.264C>T heterozygous and c.866-71 G>A heterozygous) in UMOD gene, 1 single nucleotide polymorphism (c.373+44C>G heterozygous) in REN gene, and 2 single nucleotide polymorphisms (c.100-50-49ins TCTG heterozygous and c.781-22T>C homozygous) in HNF-1βgene were detected. No pathological mutation was detected in these 3 genes. Conclusions This child is highly suspected to have primary gout caused by familial juvenile hyperuricemic nephropathy.