Objective To investigate the anti-inflammatory effects of Bupi Yichang Pills on mice with experimental colitis and its potential mechanism of action.Methods Dextran sulfate sodium(DSS)was used to model the experimental colitis,and low-,medium-and high-doses of Bupi Yichang Pills(1.5,3.0,6.0 g·kg-1·d-1)and Mesalazine(300 mg·kg-1·d-1)were fed at the same time.Mice were observed for general behavior and weighed.Hematoxylin-eosin staining was used to observe the pathological injury of colonic tissues.qPCR and ELISA were used to detect the levels of inflammatory cytokines(TNF-α,IL-1β,IL-6,IL-10,IL-35 and TGF-β1),qPCR and Western Blot were used to detect the mRNA and protein levels of glucose transporters and glycolytic kinases.Results Low-,medium-and high-doses of Bupi Yichang Pills significantly down-regulated disease activity index in colitis mice(P＜0.05,P＜0.01).The body mass and colon length were significantly increased,while colon mass,colon mass index and unit colon mass index were significantly reduced(P＜0.05,P＜0.01),and ulcer formation and inflammatory cell infiltration in colonic tissue were significantly improved.In addition,medium-and high-doses of Bupi Yichang Pills significantly down-regulated the mRNA levels and concentrations of pro-inflammatory cytokines including TNF-α,IL-1β and IL-6(P＜0.01),while significantly up-regulated the mRNA levels and concentrations of anti-inflammatory cytokines such as IL-10,IL-35 and TGF-β1(P＜0.01).We further found that high-dose of Bupi Yichang Pills significantly down-regulated the mRNA and protein expressions of glucose transporters(Glut1,Glut2,Glut4)and glycolytic kinases(HK2,Aldolase A,PKM2)in colonic tissue(P＜0.01).Conclusions Bupi Yichang Pills effectively alleviates DSS-induced experimental colitis,and its specific mechanism of action is related to the improvement of glycolytic metabolic pathways and the regulation of inflammatory cytokine expression.

Objective:To explore the application of 18F-flurodeoxyglucose positron emission tomo-graphy/computed tomography(18F-FDG PET/CT)in rheumatic diseases,to compare these different ima-ging features,and to describe the current PET/CT imaging status in clinical practice.Methods:A total of 486 cases in our department from January 2012 to December 2018 were enrolled in this study,and 18 F-FDG PET/CT examination was performed in all the patients.The clinical use of 18F-FDG PET/CT was retrospectively analyzed to discuss the clinical application and its imaging characteristics of rheumatic diseases.Categorical data were used to ascertain prevalence statistics,whereas continuous data were used to delineate means and standard deviations.Independent sample t test,Chi square test and Mann-Whit-ney U test were used for statistical analysis.A P-value of＜0.05 was considered significant.Results:(1)From 2012 to 2018,totally 486 patients in the Department of Rheumatology and Immunology under-went18F-FDG PET/CT examination,accounting for 5.30％of the total number of PET/CT examinations in the whole hospital.In this study,304 of the 486 patient were female(62.55％),182 of them were male(37.45％),the average age of the patients was(53.21±18.81)years,and the proportion of the patients aged 45-65(227/486,46.71％)was the highest group.(2)Three leading purposes of the PET/CT examination in our department were to exclude cancers(55.56％),assist in diagnosis(24.60％)and evaluate the disease activity(19.84％).(3)Of the 486 patients who underwent 18F-FDG PET/CT,327 cases might indicate a differential diagnosis of rheumatic disease,of which,292 ca-ses were highly suggestive of diagnosis,including 61 cases of myositis,60 cases of vasculitis,37 cases of adult still's disease,32 cases of IgG4 related diseases,30 cases of rheumatoid arthritis,22 cases of Sj?gren's syndrome,22 cases of systemic lupus erythematosus,and 9 cases of rheumatic polymyalgia;the remaining 35 cases only prompted the possibility of autoimmune disease.Of the 486 patients,74 ca-ses suggested the diagnosis of cancers,25 cases indicated the diagnosis of infectious diseases,while 60 cases could not show any diagnostic values.Ten patients with rheumatic disease were followed up with a post-treatment repeat PET/CT,and the findings in remission showed reduced 18F-FDG metabolic activity as well as a reduction in the extent of metabolic hypertrophic lesions.Conclusion:There are some typi-cal sign of 18F-FDG PET/CT for diffuse connective tissue diseases,therefore 18F-FDG PET/CT has auxi-liary effect on the classification diagnosis of rheumatic diseases,especially for the exclusion of cancers.

Pulmonary blast injury has become the main type of trauma in modern warfare, characterized by externally mild injuries but internally severe injuries, rapid disease progression, and a high rate of early death. The injury is complicated in clinical practice, often with multiple and compound injuries. Currently, there is a lack of effective protective materials, accurate injury detection instrument and portable monitoring and transportation equipment, standardized clinical treatment guidelines in various medical centers, and evidence-based guidelines at home and abroad, resulting in a high mortality in clinlcal practice. Therefore, the Trauma Branch of Chinese Medical Association and the Editorial Committee of Chinese Journal of Trauma organized military and civilian experts in related fields such as thoracic surgery and traumatic surgery to jointly develop the Clinical treatment guideline for pulmonary blast injury ( version 2023) by combining evidence for effectiveness and clinical first-line treatment experience. This guideline provided 16 recommended opinions surrounding definition, characteristics, pre-hospital diagnosis and treatment, and in-hospital treatment of pulmonary blast injury, hoping to provide a basis for the clinical treatment in hospitals at different levels.

Objective To investigate the regulatory effect of Bupi Yichang pill(BPYCP)on CD4+T cell subsets of ulcerative colitis(UC)mice.Methods Forty-eight C57BL/6 mice were randomly divided into 4 groups:the control group(n=10),the model group(DSS group,n=13),the model +BPYCP group(DSS+BPYCP group,n=13)and the model+ mesalazine(5-ASA)group(DSS+5-ASA group,n=12).The mouse UC model was induced by 2.5%dextrosan sulfate(DSS)solution.The DSS+BPYCP group and the DSS+5-ASA group were given BPYCP or 5-ASA for 2 weeks,respectively,and fecal viscosity and blood in stool were observed.The colon length was measured.Colonic mass index and unit colonic mass index were calculated.Hematoxylin-eosin(HE)staining was used to observe pathological changes of colon and to score the pathological tissue damage.The level of CD4+T cell subsets in mesenteric lymph nodes was detected by flow cytometry.The expression levels of cytokines interferon-γ(INF-γ),interleukin(IL-4),IL-17A,IL-10 and IL-21 secreted by CD4+T cell subsets in colon tissue were detected by ELISA.Real-time fluorescence quantitative PCR was used to detect colon tissue CD4+T cell subset nuclear transcription factors,mRNA expression levels of T-frame protein 21(T-bet),GatA-binding protein 3(GATA-3),retinoa-associated nuclear orphan receptor γt(RORγt),B cell lymphoma-6(Bcl-6)and Foxp3 in rats.Results Compared with the DSS group,the diarrhea and hematostoecium symptoms of UC mice in the DSS+BPYCP group and the DSS+5-ASA group were significantly improved,body weight and colon length of mice were increased,and colon mass,colon mass index and unit colon mass index were decreased(P＜0.05).The mucosal epithelium was more complete than that in the DSS group,and gland arrangement was more regular.The inflammatory cell infiltration was less,and the pathological tissue damage score was significantly decreased(P＜0.01).The proportion of Th2 cells in mesenteric lymph nodes was decreased,the proportion of Th17 cells and the level of IL-17A were decreased,and the mRNA levels of T-bet,GATA-3,RORγt and Bcl-6 in colon tissue were decreased(P＜0.05).In the DSS+BPYCP group,the proportion of Th1 cells decreased,the proportion of CD4+CD25+Treg cells,CD4+CD25+Foxp3+Treg cells and the level of IL-10 increased,and the proportion of CD4+CXCR5+Tfh cells and the level of IL-21 decreased.The level of Foxp3 mRNA increased(P＜0.05).The proportion of Th1 cells and the level of IFN-γ were decreased in the DSS+5-ASA group(P＜0.05).Conclusion BPYCP may alleviate UC by remodeling the homeostasis of CD4+T cell subpopulations.

Objective:To explore the clinical application and long-term safety of hydroxychloroquine sulfate (HCQ) in the treatment of rheumatic diseases.Methods:A multi-center cross-sectional study was conducted between August 2017 and August 2018 in a random sample of eleven medical institutions of rheumatology and immunology in China. Patients who took HCQ for more than 3 months were enrolled into this study. The cumulative dose and long-term side effects of HCQ were recorded. The changes of laboratory indexes before and after treatment with HCQ were analyzed. Categorical variables were presented with counts and proportions, and evaluated by Chi-square test. Continuous parametric data were presented as Mean±standard deviation, and evaluated by Student's t test or Mann-Whitney U test. P-values less than 0.05 were considered statistically significant. Results:A total of 886 patients with rheumatic diseases were enrolled into this study, including 505 cases with systemic lupus erythematosus (57.0%), 210 cases with rheumatoid arthritis (23.7%), 80 cases with Sj?gren's syndrome (9.0%), 57 cases with undifferentiated connective tissue disease (6.4%), 12 cases of systemic vasculitis (1.4%), 10 cases of mixed connective tissue disease (1.1%), 7 cases of myositis (0.8%) and 5 cases with systemic sclerosis (0.6%). The most common long-term side effects of HCQ was skin or mucous lesions (12.4%) and vision problems (8.0%). Other adverse reactions included problems of digestive system (3.0%), nervous system (2.1%), musculoskeletal system (1.1%) and cardiovascular system (0.9%). 140 cases (15.8%) had stopped taking HCQ during the treatment. More than half of them decided to stop taking medicine by themselves. Fifty-four patients (6.1%) stopped using HCQ due to side effects while 24 of them took it again, and another 12 patients (1.4%) stopped the drug due to remission of illness. Patients were divided into three groups according to the cumulative dose of HCQ: less than 500 g, 500-1 000 g and more than 1 000 g respectively. There was significant difference in the incidence of long-term side effects among the three groups ( χ2=6.382, P=0.041). The last group (more than 1 000 g) suffered the highest incidence of long-term adverse reactions (37.1%). No severe adverse drug reactions were observed in this study. Conclusion:Hydroxychloroquine is widely used in the treatment of rheumatic diseases. The incidence of long-term side effects is 20.4%, is 6.1% lead to drug withdrawal, which are especially related to the cumulative doses. It should be adjusted properly according to the clinical application.

Objective:To investigate the high resolution vessel wall imaging (HR-VWI) features of basilar artery (BA) in patients with acute isolated pontine infarction (AIPI) of different infarct types, and explore the pathogenesis of AIPI.Methods:A retrospective analysis of clinical and imaging data of 52 patients with AIPI admitted to our hospital from June 2016 to November 2019 was performed. According to the morphology and location distribution of pontine high-signal lesions in diffusion-weighted imaging (DWI), these patients were divided into paramedian pontine infarction (PPI) group and small deep pontine infarction (SDPI) group. The general clinical data, modified National Institute of Health stroke scale (mNIHSS) scores at admission and discharge, modified Rankin scale (mRS) scores, and incidence of basilar artery plaques and plaque characteristics of basal artery in HR-VWI of patients from the two groups were compared.Results:Among the 52 AIPI patients, there were 28 patients with PPI (54%) and 24 with SDPI (46%). The mNIHSS scores at admission and discharge in the PPI group were significantly higher than those in the SDPI group ( P<0.05). The incidence of basilar artery plaques in PPI group was significantly higher than that in SDPI group (92.9% vs. 62.5%, P<0.05). As compared with SDPI group, PPI group had a significantly higher incidence of right lateral wall plaques, a statistically lower incidence of ventral wall plaques, and a significantly higher incidence of centripetal plaques, and significantly increased maximum thickness of vessel wall ( P<0.05). Conclusion:The AIPI mechanism is generally related to the branch atheromatous disease of basilar artery; PPI patients have more severe clinical symptoms, more serious clogged perforation opening of the basilar artery plaque, more unstable basilar artery plaque than the SDPI group.

With the development of imaging technology, high-resolution magnetic resonance vascular wall imaging technology has been gradually applied to the risk assessment of intracranial aneurysms rupture. It has provided more comprehensive information for clinicians to assess the stability of intracranial aneurysms. This article summarizes the indicators used for assessing the risk of intracranial aneurysms rupture in recent years with high-resolution magnetic resonance vascular wall imaging.

Objective　To investigate the characteristics of high resolution vessel wall imaging (HR-VWI) imaging of unstable plaques in acute pontine infarction.Methods　Data from thirty-nine patients with symptomatic acute pontine infarction and 45 patients with asymptomatic pontine infarction in the Peopl’s Hospital of Baoan District,Shenzhen from June 2016 to November 2019 was retrospectively analyzed.The distribution of BA plaques and plaque involvement were counted on HR-VWI Quadrant.Plaque surface continuity,plaque length,vascular volume (Vouter),vascular wall volume (V wall),lumen diameter in the narrowest layer of the lumen (LD MLN),maximum diameter of the outer lumen (OD MLN ),vascular area (OA MLN),vascular wall area (WA MLN),the thickest thickness (WTmax),the plaque load (PB),and lumen stenosis rate were measured.Measurement indicators were compared between the two groups.Results　The plaque distribution,plaque discontinuity,WTmax,WA MLN,PB,and BA lumen stenosis rates between the two groups were statistically different (P<0.05).Conclusions　BA plaques with symptomatic pontine infarction are more likely to be distributed on the side wall,the surface is more discontinuous,thicker plaque thickness,larger blood vessel area and plaque load,higher luminal stenosis rate,suggesting that it has instability Plaque characteristics.

Objective:To explore the value of enhancement rate of aneurysm wall by high-resolution magnetic resonance vessel wall imaging (HR-VWI) in assessing the risk of intracranial aneurysm rupture.Methods:Seventy patients with 80 intracranial aneurysms, admitted to our hospital from January 2016 to December 2019, were chosen in our study; morphological parameters (shape, neck width, height, diameter) of the intracranial aneurysms, and signal intensity and enhancement rate of aneurysm wall were collected from HR-VWI. These patients were divided into a high-risk rupture group (PHASES scores>3) and a low-risk rupture group (PHASES scores≤3) according to PHASES scores. Univariate analysis was used to compare the differences of clinical data (age, gender, blood pressure, blood lipids, and smoking history) and aneurysm imaging data between the two groups of patients. Multivariable Logistic regression was used to determine the independent influencing factors for aneurysm rupture, and receiver-operating characteristic (ROC) curve of enhancement rate of aneurysm wall in predicting aneurysm rupture was drew to determine the best diagnostic value.Results:Univariate analysis showed that the percentages of patients with hypertension, multiple aneurysms and irregular aneurysm morphology, aneurysm height, aneurysm diameter and aneurysm wall enhancement rate were significantly different between the high-risk rupture group and low-risk rupture group ( P<0.05). Multivariate Logistic regression analysis showed that aneurysm diameter ( OR=1.647, 95%CI: 1.177-2.306, P=0.004) and aneurysm wall enhancement rate ( OR=5.317, 95%CI: 1.527-18.512, P=0.009) were independent influencing factors for rupture of intracranial aneurysms. The area of ROC curve was 0.735, the optimal cut-off value was 0.583; the sensitivity of predicting rupture of intracranial aneurysms was 72.7% and the specificity was 70.2%. Conclusion:The aneurysm wall enhancement rate is significantly correlated with risk of aneurysm rupture; when the PHASES scores>3 and aneurysm wall enhancement rate>58.3%, clinical intervention should be vigilant.

The geometric morphology of intracranial arteries has unique characteristics and laws. Congenital variation is also often seen in clinical work. Both have certain clinical significance in the occurrence and development of cerebrovascular diseases, as well as in anatomy and function. This article summarizes some of the findings on the morphology and variation of intracranial arteries in cerebrovascular disease research in recent years, and reviews the imaging techniques of intracranial arteries as well as the clinical significance of geometric morphology and congenital variation.