COVID-19 has been prevalent for three years. The virulence of SARS-CoV-2 is weaken as it mutates continuously. However, elderly patients, especially those with underlying diseases, are still at high risk of developing severe infections. With the continuous study of the molecular structure and pathogenic mechanism of SARS-CoV-2, antiviral drugs for COVID-19 have been successively marketed, and these anti-SARS-CoV-2 drugs can effectively reduce the severe rate and mortality of elderly patients. This article reviews the mechanism, clinical medication regimens, drug interactions and adverse reactions of five small molecule antiviral drugs currently approved for marketing in China, so as to provide advice for the clinical rational use of anti-SARS-CoV-2 in the elderly.

OBJECTIVE: To investigate the biomechanical characteristics of different internal fixations for Pauwels type Ⅲ femoral neck fracture with defect, and provide reference for the treatment of femoral neck fracture. METHODS: Three-dimensional (3D) finite element models of femoral neck fractures were established based on CT images, including fracture and fracture with defects. Four internal fixations were simulated, namely, inverted cannulated screw(ICS), ICS combined with medial buttress plate, the femoral neck system (FNS) and FNS combined with medial buttress plate. The von Mises stress, model stiffness and fracture displacements of fracture models under 2 100 N axial loads were measured and compared. RESULTS: When femoral neck fracture was fixed by ICS and FNS, the peak stress was mainly concentrated on the surface of the screw near the fracture line, and the peak stress of FNS is higher than that of ICS;When the medial buttress plate was combined, the peak stress was increased and transferred to medial buttress plate, with more obvious of ICS fixation. For the same fracture model, the stiffness of FNS was higher than that of ICS. Compared with femoral neck fracture with defects, fracture model showed higher stiffness in the same internal fixation. The use of medial buttress plate increased model stiffness, but ICS increased more than FNS. The fracture displacement of ICS model exceeded that of FNS. CONCLUSION For Pauwels type Ⅲ femoral neck fracture with defects, FNS had better biomechanical properties than ICS. ICS combined with medial buttress plate can better enhance fixation stability and non-locking plate is recommended. FNS had the capability of shear resistance and needn't combine with medial buttress plate.
Humans ; Femoral Neck Fractures/surgery* ; Fracture Fixation, Internal/methods* ; Bone Screws ; Bone Plates ; Biomechanical Phenomena ; Finite Element Analysis

The prevalence of diabetes in China is increasing year by year， and has become a health issue of close concern to the whole society. Glucagon-like peptide-1 （GLP-1） receptor agonist （GLP-1RA）， as a new class of glucose-lowering drugs， is now widely used in the treatment of type 2 diabetes mellitus （T2DM） because of its significant glucose-lowering efficacy and low risk of hypoglycemia. As the level of evidence for its effects on improving cardiovascular system and renal protection and reducing body mass continues to improve， its status in the treatment guidelines for T2DM is gradually increasing. Currently， nine GLP-1RA drugs have been approved for the clinical treatment of T2DM in China. Although all of these drugs exert hypoglycemic effects based on the activation of GLP-1 receptors in the body， the differences in their own structures and natural GLP-1 amino acid homology lead to large differences in pharmacokinetic parameters and clinical efficacy among different analogs. In order to enable clinicians and pharmacists to have a full understanding of the characteristics and clinical evidence of these analogs and to better perform their therapeutic effects， Liaoning Provincial Pharmaceutical Society organized clinical medicine and pharmacy experts to develop a medication guide for nine GLP-1RA drugs to provide a reference for clinical medication needs and promote rational and standardized use by compiling and summarizing the pharmacological characteristics， clinical applications， adverse reactions， interactions， the medications in special populations and medication management.

Axilla/pathology* ; Breast Neoplasms/surgery* ; China ; Humans ; Lymph Node Excision ; Lymph Nodes/pathology* ; Lymphatic Metastasis ; Mastectomy ; Neoplasm Staging ; Sentinel Lymph Node Biopsy

Background: Ongoing efforts have been made to identify new neuroimaging markers to track amyotrophic lateral sclerosis (ALS) progression. This study aimed to explore the monitoring value of multimodal magnetic resonance imaging (MRI) in the disease progression of ALS. Methods: From September 2015 to March 2017, ten patients diagnosed with ALS in Peking Union Medical College Hospital completed head MRI scans at baseline and during follow-up. Multimodal MRI analyses, including gray matter (GM) volume measured by voxel-based morphometry; cerebral blood flow (CBF) evaluated by arterial spin labeling; functional connectivity, including low-frequency fluctuation (fALFF) and regional homogeneity (ReHo), measured by resting-state functional MRI; and integrity of white-matter (WM) fiber tracts evaluated by diffusion tensor imaging, were performed in these patients. Comparisons of imaging metrics were made between baseline and follow-up using paired t-test. Results: In the longitudinal comparisons, the brain structure (GM volume of the right precentral gyri, left postcentral gyri, and right thalami) and perfusion (CBF of the bilateral temporal poles, left precentral gyri, postcentral gyri, and right middle temporal gyri) in both motor and extramotor areas at follow-up were impaired to different extents when compared with those at baseline (all P < 0.05, false discovery rate adjusted). Functional connectivity was increased in the motor areas (fALFF of the right precentral gyri and superior frontal gyri, and ReHo of right precentral gyri) and decreased in the extramotor areas (fALFF of the bilateral middle frontal gyri and ReHo of the right precuneus and cingulate gyri) (all P < 0.001, unadjusted). No significant changes were detected in terms of brain WM measures. Conclusion Multimodal MRI could be used to monitor short-term brain changes in ALS patients.
Adult ; Amyotrophic Lateral Sclerosis ; diagnostic imaging ; physiopathology ; Brain ; diagnostic imaging ; Cerebrovascular Circulation ; Disease Progression ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Multimodal Imaging ; methods ; Prospective Studies

Objective Brucine and strychnine monomer reference substance as extremely toxic substance had potential threat during transportation and utilization. In this study we investigated the homogeneity, stability and assignment accuracy of the mixture reference solution of strychnine and brucine, so as to provide reference for the quality control of extremely toxic chemical reference substances for Chinese medicine. Methods Following the assay in Chinese Pharmacopoeia volume I (2015), we prepared the mixture reference solution of brucine and strychnine, and investigated the solvents and the concentration of mixutre reference solution. The stability test lasted for 12 months. F-test was used for heterogeneity assay. Three researchers were involved for collaboration. Results Methanol and chloroform solution were selected as the solvents for the stability test. Results showed the difference was not statistically significant among various mixture solutions. The results of value assignment were 0.14 mg/mL for strychnine (sR = 0.5％)and 0.10 mg/mL for brucine (sR = 1.0％). The stability of mixture solution were better under the conditions of methanol solution at 4 ℃ or -20 ℃. Conclusion The results provide a possible way to develop the mixture solution in place of the monomer reference, and the mixture reference solution is expected for the quality control in the slices of Semen Strychni and its compound preparations.

AIM:To study the efficacy of conbercept intravitreal injection combined with retinal laser photocoagulation therapy and simple laser photocoagulation therapy on macular edema (ME) secondary to retinal vein occlusion (RVO).METHODS:Forty-eight patients (53 eyes) with macular edema secondary to retinal vein occlusion diagnosed by clinical examination from October 2014 to March 2015 were retrospectively analyzed.Among them,28 patients (31 eyes) were treated with conbercept intravitreal injection combined with retinal laser photocoagulation,which was defined as Group A.And simple laser group contained 20 patients (22 eyes),which was defined as Group B.The clinical data including the patients' best-corrected visual acuity (BCVA) and central retinal thickness (CMT) before treatment and 1wk and 3mo after treatment were observed.RESULTS:Followed up for 3mo,the average BCVA values of A and B were 0.44±0.25,0.56±0.24,respectively and the average CMT were 330.50 ± 121.71,354.67 ± 102.79μm at first week of treatment.There was no significant difference in BCVA and CMT of Group A compared with Group B.There was statistically significant in BCVA and CMT of Group A and Group B compared with before treatment (P＜0.05).The average BCVA values of A and B were 0.24±0.18,0.39±0.20,respectively and the average CMT were 252.62 ± 83.01,332.67 ± 102.33μ m at third month of treatment.There were statistically significant differences between the two groups and compared with before treatment (P＜0.05),and Group A was superior to Group B.CONCLUSION:Conbercept intravitreal injection combined with retinal laser photocoagulation therapy and simple laser photocoagulation treatment of macular edema secondary to retinal vein occlusion are both effective that macular edema is significantly reduced,and vision is stable and improved.But for serious cases,conbercept intravitreal injection can reduce retinal edema at first,then combine with retinal laser photocoagulation which has obvious therapeutic effect and it is better than simple laser photocoagulation treatment.

Brazilein is reported to have immunosuppressive effect on cardiovascular and cerebral-vascular diseases. The essential roles of innate immunity in cerebral ischemia are increasingly identified, but no studies concerning the influence of brazilein on the innate immunity receptors have been reported. The present study was designed to investigate the regulation of NOD2 (Nucleotide-binding oligomerization domain-containing protein 2) by brazilein for its protection of neuron in cerebral ischemia in vivo and oxygen-glucose deprivation in vitro. The results showed that brazilein could reverse the elevated expression of NOD2 and TNFα (tumor necrosis factor alpha) elicited by cerebral ischemia and reperfusion. This reduction could also be detected in normal mice and C17.2 cells, indicating that this suppressive effect of brazilein was correlated with NOD2. The results from GFP reporter plasmid assay suggested brazilein inhibited NOD2 gene transcription. In conclusion, brazilein could attenuate NOD2 and TNFα expression in cerebral ischemia and NOD2 may be one possible target of brazilein for its immune suppressive effect in neuro-inflammation.
Animals ; Benzopyrans ; administration & dosage ; Brain Ischemia ; drug therapy ; genetics ; immunology ; metabolism ; Cells, Cultured ; Drugs, Chinese Herbal ; administration & dosage ; Glucose ; metabolism ; Humans ; Indenes ; administration & dosage ; Male ; Mice ; Mice, Inbred ICR ; Neurons ; drug effects ; immunology ; Nod2 Signaling Adaptor Protein ; genetics ; metabolism ; Oxygen ; metabolism ; Tumor Necrosis Factor-alpha ; genetics ; immunology

Pineapple (Ananas comosus) leaves contain mainly phenolic components with antioxidant and hypolipidemic effects. One of the principle components is p-coumaric acid. In this study, the transport behavior of p-coumaric acid, was observed after the administration of pineapple leaf phenols in vitro. Simultaneously, the effect of the phenols on glucose, total cholesterol and triglycerides transportation and metabolism in HepG2 cells was also observed. The results showed that the phenols had good transport characteristics. 5 min after the administration, p-coumaric acid of the phenols could be detected, and the content of p-coumaric acid reached the peak concentration after 60 min of the administration. p-coumaric acid of phenols have time-and dose-dependent manner. While promoting glucose transporter (GLUT4) and low density lipoprotein receptor (LDLR) expression, the phenols decreased intracellular lipid content. This reduction of intracellular lipid content was highly correlated with the promotion of lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) expression, while the reduction of intracellular glucose levels was correlated with glycogen synthesis in the cells.
Ananas ; chemistry ; Biological Transport ; drug effects ; Cholesterol ; metabolism ; Glucose ; metabolism ; Hep G2 Cells ; Humans ; Lipid Metabolism ; drug effects ; Plant Extracts ; pharmacology ; Plant Leaves ; chemistry

OBJECTIVETo investigate diagnosis and therapeutic effects of knee joint synovial chondromatosis with arthroscopic.

METHODSFrom March 1995 to July 2011, 28 patients with knee joint synovial chondromatosis were treated. Among them, 18 males and 10 females ranging age from 25 to 81 (mean 55.2) years,the course of disease ranged from 0.5 to 15 (mean 5.6) years. Clinical manifestation mainly included pain, swell and functional limitation of knee joint. Knee open surgery (17 cases) and laparoscopic surgery (10 cases) were respectively used. Clinical symptom,image data,pathological manifestation and effects under arthroscopy were observed, Lysholm scoring was used to evaluate effects.

RESULTSAll patients were followed up except one lost, the duration ranging from 6 to 24 months. Lysholm score in knee open surgery was increased from (41.89 +/- 6.81) preoperatively to (67.73 +/- 7.62) postoperatively;while in laparoscopic surgery it was increased from (40.78 +/- 7.54) preoperatively to (77.46 +/- 8.43) postoperatively.

CONCLUSIONArthroscopic surgery, which has no risk of rupture of incision, nonunion, earlier to exercise, is a good method to diagnosis and treat knee joint synovial chondromatosis.

Adult ; Aged ; Aged, 80 and over ; Chondromatosis, Synovial ; diagnosis ; surgery ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; surgery ; Laparoscopy ; Male ; Middle Aged ; Treatment Outcome