Once ischemic stroke occurs,severely insufficient blood supply causes massive neuronal apoptosis and necrosis,leading to the release of damage-associated molecular patterns(DAMPs)that exacerbate neuroinflammation and worsen brain damage.As the resident efferocytes in central nervous system,microglia possess the capability to phagocytose and eliminate ap-optotic cells by efferocytosis before necrosis occurs,thereby mit-igating the release of DAMPs and the accumulation of cellular debris.This process is crucial for neuroinflammation reduction and neurorestoration.Hence,a comprehensive understanding of the regulatory mechanism of microglial efferocytosis post-ische-mia,as well as its impact on neuroinflammation and cerebral damage,has the potential to advance diagnostic and therapeutic approaches for ischemic stroke.Here,we outline the molecular mechanisms and signaling pathways involved in microglial effero-cytosis following ischemic stroke,and summarize the research progress on drugs targeting microglial efferocytosis to enhance stroke prognosis.

Tibetan medicine is an essential part of Chinese medicine and has unique theoretical experience and therapeutic advantages. According to the development principle of inheriting the essence, sticking to the truth, and keeping innovative, the supervision department should give clear and reasonable guidance considering the characteristics of Tibetan medicine, establish a standard system for quality control, clinical verification and evaluation, and accelerate the research and commercialization of new drugs. In view of the needs of drug supply-side reform and the current situation of Tibetan medicine and new pharmaceutical research, we ponder and provide suggestions on the confusion faced by the current supervision of Tibetan drug registration, hoping to contribute to the supervision strategy of Tibetan drug registration and the high-quality development of Tibetan medicine industry.
Tibet ; Medicine, Tibetan Traditional ; Quality Control ; Pharmaceutical Research ; Drug Industry

Objective To investigate the effect of Clostridium butyricum tablets combined with conventional therapy on the cholinesterase levels and albumin ( ALB) levels in patients with liver cirrhosis.Methods The 236 patients with liver cirrhosis from October 2016 to February 2018 in the Department of Gastroenterology of our hospital were selected as the study subjects.The patients were divided into the treatment group and the control group.The patients in the treatment group were given 2 g Clostridium butyricum tablets orally ,on the basis of general symptomatic treatment,3 times per day for two weeks ;the patients in the control group were stan-dard treatment.The plasma cholinesterase , ALB levels were determined by automatic analyzer.Results The cholinesterase levels in the control group and the treatment group were ( 2.87 ±1.82 ), (7.94 ±2.45) U· L-1, respectively; the ALB levels in the 2 groups were (34.02 ±3.26),(47.63 ±4.05) g· L-1,respectively;comparison between the two groups , the difference was significant ( all P ＜0.05 ) . Conclusion Clostridium butyricum tablets can significantly increase plasma cholinesterase and ALB levels in patients with liver cirrhosis .

Objective To investigate the relationship between the levels of plasma adrenaline and norepinephrine and gene polymorphism of β1 adrenergic receptor G1165C in children with enterovirus 71 (EV71) infection in hand foot and mouth disease (HFMD). Methods The polymerase chain reaction (PCR) was used to detect the expression of gene polymorphism of β1 adrenergic receptor G1165C in vitro. The levels of plasma adrenaline and norepinephrine were measured by enzyme-linked immunosorbent assay (ELISA). Results The plasma norepinephrine level of severe group was significantly higher than the mild group in children with EV71 infection in HFMD (P < 0.05); however, the levels of plasma adrenaline in two groups had no statistical differences (P > 0.05); There was no significant difference in the distribution of β1 adrenergic receptor G1165C genotype and allele between EV71 infection group and healthy control group (P > 0.05). Further analysis of EV71 infection group by dividing it into mild and severe groups showed that there was no significant difference in the distribution of genotype and allele between these two groups as well (P > 0.05). There was no significant difference in the levels of epinephrine and norepinephrine in different genotypes of EV71 infection group (P > 0.05), and in the levels of plasma epinephrine and norepinephrine in the mild and severe groups (P > 0.05). Conclusions As the disease gets worse, the plasma norepinephrine level has a rising trend in children with EV71 infection in HFMD, which is an important indicator to evaluate the progress of the disease. However, the gene polymorphism of β1 adrenergic receptor G1165C have no significant correlation, not only with the susceptibility and severity of EV71 infection in hand, foot and mouth disease, but also with the levels of catecholamine.

Thymic carcinoid is a rare neoplasm with unclear risk factors and controversial classifications .Clinical manifestations vary from asymptomatic to many nonspecific symptoms , among which endocrinopathy seems to be as-sociated with poor prognosis .Image studies show no specificity both in CT and PET/CT, but are of great value in clinical staging .Ki67 index has been found to be a powerful tool for grading neuroendocrine tumors and further studies should be made .The diagnosis of thymic carcinoid mainly depends on pathology and immunohistochemistry plays a role in differential diagnosis .Radical resection is the first choice in treatment , and target therapy becomes possible with the development in molecular pathology .

Objective To prospectively evaluate the value of integrinαvβ3 receptor imaging approach based on single photon emission computed tomography/computed tomography(SPECT/CT),using 99mTc-3PRGD2 as the tracer,in diagnosis and staging of non-small cell lung cancer( NSCLC)compared with 18 F-FDG positron emisson tomography/computed tomography( PET/CT). Methods From February 2011 to December 2012 , 65 patients with suspicious lung lesions were recruited with informed consent in Peking Union Medical Col-lege Hospital,including 41 males and 24 females,with a mean age of(60 ± 11)years. The patients under-went both 99mTc-3PRGD2 SPECT/CT and 18F-FDG PET/CT within one week. After pathological diagnosis, all the patients were followed up until death or for at least two years. Receiver operating characteristic ( ROC)curve,Z test,and Chi-square test were used to compare the diagnostic performance of the two ima-ging methods in assessing lung lesions and mediastinal lymph nodes. Results Sixty-five lung lesions in 53 patients were pathologically diagnosed as NSCLC,and 14 lung lesions in 12 patients were proved as benign. Based on the American Joint Committee on Cancer/Union for International Cancer Control( AJCC-UICC)stand-ard,248 regions of lymph nodes had metastasis and 56 were negative regions. 99m Tc-3PRGD2 SPECT/CT was found to have higher specificity compared with 18 F-FDG PET/CT in the per-region diagnosis of lymph node metas-tasis(94. 6% vs. 75. 0%,P=0. 008),whereas the sensitivity of the two methods showed no statistically signifi-cant difference(88. 3% vs. 90. 7%,P=0. 557). There was no significant difference between the two methods in diagnostic performance for lung lesion( Z =0. 82 ,P =0. 410 ). Conclusion 99m Tc-3PRGD2 SPECT/CT shows high specificity in the diagnosis of lymph node metastasis from NSCLC,which may complement 18 F-FDG PET/CT in diagnosis and benefit surgical decision-making for patients with lung cancer.

BACKGROUNDIn China, no multicenter double-blinded prospective randomized controlled study on labor induction has been conducted till now. This study is to evaluate the efficacy and safety of intravaginal accurate 25-μg misoprostol tablets for cervical ripening and labor induction in term pregnancy in nulliparous women.

METHODSThis was a double-blinded, prospective randomized controlled study including nulliparous women from 6 university hospitals across China. Subjects were randomized into misoprostol or placebo group with the sample size ratio set to 7:2. Intravaginal 25-μg misoprostol or placebo was applied at an interval of 4 h (repeated up to 3 times) for labor induction. Primary outcome measures were the incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h. Safety assessments included the incidences of maternal morbidity and adverse fetal/neonatal outcomes.

RESULTSA total of 173 women for misoprostol group and 49 women for placebo were analyzed. The incidence of cumulative Bishop score increases ≥3 within 12 h or vaginal delivery within 24 h was higher in the misoprostol group than in the placebo (64.2% vs. 22.5%, relative risk [RR]: 2.9, 95% confidence interval [CI]: 1.4-6.0). The incidence of onset of labor within 24 h was significantly higher in the misoprostol group than in the placebo group (48.0% vs. 18.4%, RR: 2.6, 95% CI: 1.2-5.7); and the induction-onset of labor interval was significantly shorter in the misoprostol group (P = 0.0003). However, there were no significant differences in the median process time of vaginal labor (6.4 vs. 6.8 h; P = 0.695), incidence (39.3% vs. 49.0%, RR: 0.8, 95% CI: 0.4-1.5) and indications (P = 0.683) of cesarean section deliveries, and frequencies of maternal, fetal/neonatal adverse events between the groups.

CONCLUSIONIntravaginal misoprostol 25 μg every 4 h is efficacious and safe in labor induction and cervical ripening.

Administration, Intravaginal ; Adult ; Cervical Ripening ; drug effects ; Double-Blind Method ; Female ; Humans ; Labor, Induced ; methods ; Misoprostol ; administration & dosage ; therapeutic use ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Third ; Young Adult

OBJECTIVETo investigate the optimal glycated haemoglobin (HbA1c) cut off points and evaluate the impact of HbA1c on diabetes and pre-diabetes in middle-aged and elderly population.

METHODSSubjects were recruited from Shanghai Changfeng Study. A total of 1973 community-based participants (age ⋝45) without known diabetes underwent oral glucose tolerance test (OGTT) by using a 75-g oral glucose load and HbA1c was measured by using high performance liquid chromatography (HPLC). Subjects were classified as normal glucose tolerance (NGT), pre-diabetes(impaired glucose regulation, IGR) and new diagnosed diabetes (NDD) per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve (ROC).

RESULTSAmong 1973 subjects, 271 (13.7%) were diagnosed as NDD and 474 (24.0%) as IGR by using OGTT. HbA1c was 5.7%±0.7% in this population. Use of 6.5% as the HbA1C cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population (AUC 0.829, 95% CI 0.798-0.860, P<0.001) with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity (44.9%) and specificity (66.7%) with an AUC of 0.571 for HbA1c when 5.8% was used as the cutoff point. Participants detected with HbA1c⋝6.0% were associated with nearly the same metabolic characteristics, including body mass index (BMI), blood pressure, lipid profile and urine albumin-creatinine ratio (uACR) compared with diabetic subjects detected by OGTT.

CONCLUSIONThe optimum HbA1c cutoff point for diabetes in our study population was lower than ADA criteria, and HbA1c may not be used to identify IGR.

Aged ; China ; Diabetes Mellitus ; diagnosis ; metabolism ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Male ; Middle Aged ; Prediabetic State ; diagnosis ; metabolism

OBJECTIVETo explore the mechanism of acupotomy lysis in treatment of the third lumbar vertebrae transverse process syndrome.

METHODSOne hundred and eighty patients were randomly assigned into an acupotomy group and an electroacupuncture (EA) group, 90 cases in each group. The acupotomy group was treated with acupotomy on the tip of the 3rd lumbar vertebrae transverse process (tender point) combination with massage manipulation of hyperflexion and hyperextension on the waist, once a week for 3 weeks. The EA group was treated with EA at bilateral Shenshu (BL 23), Yaoyangguan (GV 3), Ashi point (local tender point) and ipsilateral Weizhong (BL 40), 3 times a week for 3 weeks. The 500 g pressure displacement and the energy absorption ratio were measured by JZL-II soft tissue tension meter and the clinical effect was evaluated by JOA low back pain scale before treatment, after treatment and 6 months after treatment.

RESULTSAfter treatment and at follow-up visit, the 500 g pressure displacement in the acupotomy group increased significantly (both P < 0.01), but it was decreased significantly in the EA group (P < 0.05, P < 0.01). The energy absorption ratio in the acupotomy group after treatment and at follow-up visit increased significantly (both P < 0.01), and in the EA group, there was no significant difference after treatment as compared with that before treatment (P > 0.05), but it was increased significantly at follow-up visit (P < 0.01). The total therapeutic level distribution in the acupotomy group was better than that in the EA group after treatment and 6 months after treatment (P < 0.05, P < 0.01).

CONCLUSIONAcupotomy therapy can significantly increase the 500 g pressure displacement and the energy absorption ratio of the local soft tissue around the third lumbar vertebrae transverse process, decrease the local soft tissue tension so as to alleviate pain. The clinical effect of the acupotomy is superior to that of electroacupuncture.

Acupuncture Points ; Acupuncture Therapy ; methods ; Adult ; Aged ; Electroacupuncture ; Humans ; Lumbar Vertebrae ; Middle Aged ; Spinal Diseases ; physiopathology ; therapy ; Syndrome

BACKGROUNDUse of neoadjuvant chemotherapy necessitates assessment of response to cytotoxic drugs. The aim of this research was to investigate the effectiveness of dynamic contrast-enhanced magnetic resonance imaging (MRI) for evaluating clinical responses to neoadjuvant chemotherapy in breast cancer patients.

METHODSWe examined patients receiving neoadjuvant chemotherapy for primary breast cancer between October 2007 and September 2008. Dynamic contrast-enhanced MRI was used to examine breast tumors prior to and after neoadjuvant chemotherapy. The MRI examination assessed tumors using Response Evaluation Criteria in Solid Tumors (RECIST). The Miller-Payne grading system was used as a histopathological examination to assess the effect of the treatment. We examined the relationship between the results of RECIST and histopathological criteria. In addition, we used time-signal intensity curves (MRI T-SI) to further evaluate the effects of neoadjuvant chemotherapy on tumor response.

RESULTSMRI examination of patients completing four three-week anthracycline-taxanes chemotherapy treatment revealed that no patients had complete responses (CR), 58 patients had partial responses (PR), 29 patients had stable disease (SD), and four with progressive disease (PD). The effectiveness of neoadjuvant chemotherapy (CR + PR) was 63.7% (58/91). The postoperative histopathological evaluations revealed the following: seven G5 (pCR) cases (7.7%), 39 G4 cases (42.9%), 16 G3 cases (17.6%), 23 G2 cases (25.3%), and six G1 cases (6.6%). The effectiveness (G5 + G4 + G3) was 68.1% (62/91). MRI T-SI standards classified 53 responding cases, 29 stable cases, and nine progressing cases. These results indicated that the treatment was 58.2% effective (53/91) overall.

CONCLUSIONSDynamic contrast-enhanced MRI and histopathological standards were highly correlated. Importantly, MRI T-SI evaluation was found to be useful in assessing the clinical effectiveness of neoadjuvant chemotherapy.

Adult ; Aged ; Anthracyclines ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; Contrast Media ; chemistry ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Neoadjuvant Therapy ; Taxoids ; therapeutic use