With the increasing incidence of diabetes mellitus in recent years， cardiomyopathy caused by diabetes mellitus has aroused wide concern and this disease is characterized by high insidiousness and high mortality. The early pathological changes of diabetic cardiomyopathy （DCM） are mitochondrial structural disorders and loss of myocardial metabolic flexibility. The turbulence of mitochondrial quality control （MQC） is a key mechanism leading to the accumulation of damaged mitochondria and loss of myocardial metabolic flexibility， which， together with elevated levels of oxidative stress and inflammation， trigger changes in myocardial structure and function. Qi deficiency and stagnation is caused by the loss of healthy Qi， and the dysfunction of Qi transformation results in the accumulation of pathogenic Qi， which further triggers injuries. According to the theory of traditional Chinese medicine （TCM）， DCM is rooted in Qi deficiency of the heart， spleen， and kidney. The dysfunction of Qi transformation leads to the generation and lingering of turbidity， stasis， and toxin in the nutrient-blood and vessels， ultimately damaging the heart. Therefore， Qi deficiency and stagnation is the basic pathologic mechanism of DCM. Mitochondria， similar to Qi in substance and function， are one of the microscopic manifestations of Qi. The role of MQC is consistent with the defense function of Qi. In the case of MQC turbulence， mitochondrial structure and function are impaired. As a result， Qi deficiency gradually emerges and triggers pathological changes， which make it difficult to remove the stagnant pathogenic factor and aggravates the MQC turbulence. Ultimately， DCM occurs. Targeting MQC to treat DCM has become the focus of current research， and TCM has the advantages of acting on multiple targets and pathways. According to the pathogenesis of Qi deficiency and stagnation in DCM and the modern medical understanding of MQC， the treatment should follow the principles of invigorating healthy Qi， tonifying deficiency， and regulating Qi movement. This paper aims to provide ideas for formulating prescriptions and clinical references for the TCM treatment of DCM by targeting MQC.

Gorham-Stout disease(GSD)is a sporadic chronic disease characterized by progressive bone dissolution,absorption,and disappearance along with lymphatic vessel infiltration in bone-marrow cavities.Although the osteolytic mechanism of GSD has been widely studied,the cause of lymphatic hyperplasia in GSD is rarely investigated.In this study,by comparing the RNA expression profile of osteoclasts(OCs)with that of OC precursors(OCPs)by RNA sequencing,we identified a new factor,semaphorin 3A(Sema3A),which is an osteoprotective factor involved in the lymphatic expansion of GSD.Compared to OCPs,OCs enhanced the growth,migration,and tube formation of lymphatic endothelial cells(LECs),in which the expression of Sema3A is low compared to that in OCPs.In the presence of recombinant Sema3A,the growth,migration,and tube formation of LECs were inhibited,further confirming the inhibitory effect of Sema3A on LECs in vitro.Using an LEC-induced GSD mouse model,the effect of Sema3A was examined by injecting lentivirus-expressing Sema3A into the tibiae in vivo.We found that the overexpression of Sema3A in tibiae suppressed the expansion of LECs and alleviated bone loss,whereas the injection of lentivirus expressing Sema3A short hairpin RNA(shRNA)into the tibiae caused GSD-like phenotypes.Histological staining further demonstrated that OCs decreased and osteocalcin increased after Sema3A lentiviral treatment,compared with the control.Based on the above results,we propose that reduced Sema3A in OCs is one of the mechanisms contributing to the pathogeneses of GSD and that expressing Sema3A represents a new approach for the treatment of GSD.

ObjectiveTo observe the clinical efficacy and relative mechanism of the Modified Wenshen Yixin Formula （温肾益心方加减， MWYF） as an auxiliary treatment of coronary heart disease （CHD） complicated with hypothyroidism of spleen-kidney yang deficiency. MethodsA total of 135 CHD patients complicated with hypothyroidism and spleen-kidney yang deficiency were included and divided into control group （67 cases） and experimental group （68 cases） according to the patients' wishes of herbal medicine administration. The control group was given conventional western medicine， while the treatment group was additionally given MWYF， 1 dose per day； both groups were treated for 8 weeks. The traditional Chinese medicine （TCM） syndrome scores， angina scores， SF-36 scores， thyroid function indicators including thyroid stimulating hormone （TSH）， thyroxine （T4） and triiodothyronine （T3）， as well as serum cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， monocyte chemoattractant ligand 2 （CCL2）， and tumor necrosis factor-related activator protein （CD40L） levels before and after treatment were compared between the two groups. The dosage and reduction and discontinuation rate of thyroid hormone preparations after treatment were compared between the two groups. The effectiveness regarding TCM syndrome and angina pectoris was evaluated， and the safety was assessed. ResultsBias was adjusted by matching on propensity score， and 102 cases were finally included in the statistical analysis， with 51 cases in each group. The total effective rate regarding TCM syndrome ［94.12% （48/51） versus 64.71% （33/51）］， the total effective rate regarding angina pectoris ［80.39% （41/51） versus 62.75% （32/51）］， and the reduction and discontinuation rate of thyroid hormone preparation ［39.21% （20/51） versus 5.88% （3/51）］ were significantly higher in the experimental group than those in the control group （P＜0.05 or P＜0.01）. After treatment， the total TCM syndrome score， individual scores of major symptoms ， the major symptoms score， the secondary symptoms score， angina pectoris score， and TSH level were significantly reduced （P＜0.01）， while all dimensions of SF-36 scores， T4， T3， and cAMP levels significantly increased in both groups （P＜0.05 or P＜0.01）. The dosage of thyroid hormone preparations and the levels of cGMP， CCL2， and CD40L in the experimental group significantly decreased after treatment （P＜0.01）. When compared between the two groups after treatment， the total TCM syndrome score， the major symptoms score， the scores of individual major symptom （chest tightness， chest pain， fear of cold， cold limbs， waist and kness soreness and weakness）， the secondary symptoms score， angina pectoris score， TSH， cGMP， CCL2， and CD40L levels of the experimental group were significantly lower than those of the control group （P＜0.05 or P＜0.01）， while all dimension scores of SF-36， T4， T3， and cAMP levels were significantly higher （P＜0.01）. A total of three adverse events occurred during treatment， none of which were judged to be related to the interventions of this study. ConclusionMWYF can significantly ameliorate the TCM syndrome， angina pectoris， quality of life and thyroid function in CHD patients complicated with hypothyroidism and spleen-kidney yang deficiency， and can promote the reduction and disconti-nuation of thyroid hormone preparations. The mechanism may be related to the regulation of cAMP/cGMP balance， the regulation of hypothalamic-pituitary-thyroid metabolic axis and the reduction of immune inflammation.

ObjectiveTo explore the effects of horse-riding simulator exercise on posture control, balance, walking and activities of daily living (ADL) in patients with ataxia after posterior circulation stroke. MethodsFrom September, 2018 to August, 2021, 49 stroke inpatients in Beijing Bo'ai Hospital were randomly divided into control group (n = 27) and exercise group (n = 22). Both groups accepted routine medicine and rehabilitation, while the exercise group accepted horse-riding exercise in addition, for four weeks. They were assessed with International Cooperative Ataxia Rating Scale (ICARS), Fugl-Meyer Assessment-Balance (FMA-B), Berg Balance Scale (BBS), Postural Assessment Scale for Stroke Patients (PASS), Timed 'Up and Go' Test (TUGT) and modified Barthel Index (MBI) before and after treatment. ResultsAll the indexes improved after treatment in both groups (|t| > 6.019, P < 0.001), while the scores of BBS and PASS, and timed of TUGT were better in the exercise group than in the control group (|t| > 2.212, P < 0.05). ConclusionHorse-riding simulator exercise can further improve the postural control, balance and walking abilities for patients with ataxia after stroke.

OBJECTIVE: To investigate the efficacy and safety of the bladder training in male patients before urinary catheter removal after mid-low rectal cancer surgery. METHODS: This was a prospective, open, randomized controlled study. INCLUSION CRITERIA: male patients; pathologically diagnosed as mid-low rectal adenocarcinoma; distance from tumor lower edge to anal margin ≤10 cm; standard radical surgery for rectal cancer, including intestinal resection and regional lymph node dissection. EXCLUSION CRITERIA: previous history of benign prostatic hyperplasia or history of prostate surgery; bladder dysfunction such as dysuria and urinary retention before surgery; local resection of rectal tumor or extended resection. According to the above criteria, 92 patients who underwent colorectal surgery at the Union Hospital of Fujian Medical University from June to December 2016 were prospectively included. The patients were randomly divided into bladder training group (n=43) and bladder non-training group (n=49) according to the random number table method. The study was approved by the Ethics Committee of the Union Hospital of Fujian Medical University (ethical approval number: 2016KY005) and registered with the China Clinical Trial Registration Center (ChiCTR) (registration No.ChiCTR-IOR-16007995). The implementation of patient's treatment measures, the data collection and analysis were based on the three-blind principle, using envelopes for distribution concealment. In the bladder training group, bladder training was routinely performed from the first day after operation to catheter removal, and in bladder non-training group the catheter was kept open till its removal. The catheter was removed in the early morning at the 5th day after surgery, and the spontaneous urine output was recorded and the residual urine volume of the bladder was measured after the first urination. The international prostate symptom score (IPSS) was applied to evaluate the patient's urinary function before and after surgery. RESULTS: The age of whole group was (58.6±10.9) years old, the body mass index was (22.4±2.7) kg/m , and the distance from tumor lower edge to anal margin was (6.5±1.9) cm. The baseline data, such as age, body mass index, distance from tumor lower edge to anal margin, preoperative IPSS score, preoperative bladder residual urine volume, neoadjuvant radiotherapy and chemotherapy, preventive ileostomy and surgical procedure were not significantly different between two groups (all P>0.05). There was no significant difference in IPSS scores evaluated at the second day (3.6±4.0 vs. 3.5±3.4, t=0.128, P=0.899) and one month (3.7±2.9 vs. 3.0±3.1, t=1.113, P=0.269) after catheter removal between the bladder training group and bladder non-training group. No significant difference in the postoperative residual urine volume of bladder (media 44 ml vs. 24 ml, Z=-1.466, P=0.143), the first spontaneous urination volume (median 200 ml vs. 150 ml, Z=-1.228, P=0.219) after catheter removal, and postoperative hospital stay [(8.2±4.5) days vs. (9.1±5.5) days, t=-0.805, P=0.423] was found. Urinary infection rate was 20.9%(9/43) in the training group, which was even higher than 8.2%(4/49) in the non-training group, but the difference was not significant(χ²=3.077, P=0.079). No patient needed re-catheterization in either group. CONCLUSIONS The routine bladder training after mid-low rectal cancer surgery does not improve the urinary function, and can not reduce the residual urine volume of bladder after catheter removal. This routine clinical practice is not helpful for the bladder function recovery after rectal cancer surgery.
Aged ; China ; Humans ; Laparoscopy ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Rectal Neoplasms ; surgery ; therapy ; Treatment Outcome ; Urinary Bladder ; surgery ; Urinary Retention ; therapy

Objective To analyze the results of theoretical test and clinical skills examination of standardized resident training gradua-tion exam in Beijing in recent years, to improve the examination standards and assessment models. Methods The results of theoretical test and clinical skills examination from 2011 to 2016 were collected. The difficulty, degree of differentiation, and factors related with the result of clinical skills examination were analyzed. Results The test paper is difficult with good degree of differentiation from 2014 to 2016. Edu-cation degree and year were not related with the clinical skills (P>0.05), while the hospital level was (P<0.05). Conclusion The standardized training and assessment of residents in rehabilitation medicine need continuously attention. Combined with the results of the assessment and the problems exposed in the assessment, a feasible scheme should be put forward, in order to improve the quality of resident training.

Objective To explore the clinical characteristics and rehabilitation of apraxia with unilateral neglect after corpus callosum in-farction. Methods A case of apraxia with unilateral neglect after corpus callosum infarction was discussed. Results After rehabilitation, the apraxia and unilateral neglect were improved. Conclusion For similar cases, rehabilitation can significantly improve the symptoms and ac-tivities of daily living.

Objective To observe the effect of Tongqiaohuoxue decoction on cognitive impairment in rats with traumatic brain injury and explore the mechanisms. Methods 70 Sprague-Dawley rats were randomized into normal group (n=10), sham operated group (n=20), untreated group (n=20) and treatment group (n=20). Controlled cortical impact device was utilized to establish traumatic brain injury model. The treatment group received Tongqiaohuoxue decoction 5 ml/d, and other groups received distilled water. The cognitive function of rats was evaluated with Morris water maze 1, 2, 3, 4 weeks post operation. And the rats were sampled to test the expression of brain-derived neu-rotrophic factor (BDNF) and synaptophysin (Syn) I in hippocampus through immunohistochemistry. Results The escape latency was longer in the untreated group than in the normal group in all the time points (P<0.05), and was longer in the treatment group than in the normal group 1 and 2 weeks after injury (P<0.05), with no significant difference 3 and 4 weeks after injury (P>0.05). And it was shorter in the treat-ment group than in the untreated group 3 and 4 weeks after injury (P<0.05). The percentage of swimming time was lower in the untreated group than in the normal group in all the time points (P<0.05), and was lower in the treatment group than in the normal group 1, 2, and 3 weeks after injury (P<0.05), with no significant difference 4 weeks after injury (P>0.05). And it was higher in the treatment group than in the untreated group weeks after injury (P<0.05). The BDNF expression was lower in the untreated group than in the normal group 1 and 2 weeks after injury (P<0.05), with no significant difference 3 and 4 weeks after injury (P>0.05). It was higher in the treatment group than in the normal group 4 weeks after injury (P<0.01), and was higher in the treatment group than in the untreated group 2, 3 and 4 weeks after in-jury (P<0.05). The Syn I expression was lower in the untreated group than in the normal group in all the time points (P<0.001), and was low-er in the treatment group than in the normal group 1, 2 and 3 weeks after treatment (P<0.01). And it was higher in the treatment group than in the untreated group 3 and 4 weeks after injury (P<0.01). Conclusion Tongqiaohuoxue decoction could improve the cognitive function in rats with traumatic brain injury. The change in expression of BDNF and Syn I might be associated with the improvements.

Chronic Disease ; Cresols ; toxicity ; Humans ; Multiple Organ Failure ; chemically induced

Objective To investigate any correlation between diffusion tensor imaging (DTI) results and Montreal cognitive assessment (MoCA) scores after severe traumatic brain injury (TBI).Methods Eight male pa-tients with chronic severe TBI were given the MoCA (including memory,attention,speech and executive function).DTI was used to quantify the fractional anisotropy (FA) of white matter fiber tracts in the radial and longitudinal fasciculus,under longitudinal fasciculus,internal capsule,corpus callosum genu and body,and the cingulate cortex.Pearson correlation coefficients were calculated to quantify the correlation between the FA values and MoCA scores.Results There was a positive correlation between FA in the corpus callosum body,corpus callosum genu and the superior longitudinal fasciculus and MoCA total scores.Conclusion The MoCA scores of patients with chronic severe TBI are related to white matter damage in the corpus callosum body,corpus callosum genu and the superior longitudinal fasciculus.