The Department of Thoracic Surgery of Shanghai Chest Hospital has performed esophageal function testing for over 30 years, being the only department of its kind in China with this capability. The pressure testing and 24-hour pH/impedance monitoring of the esophagus is of great help to assist in the diagnosis and treatment of benign and malignant esophageal diseases related to it. Thanks to the esophageal function test, in addition to the routine various endoscopic anti-reflux procedures, our hospital has taken the lead in China in recent years to carry out a series of clinical and research work for benign esophageal diseases, such as the development of magnetic ring, double nedoscopic combination and new anti-reflux endoscopic techniques. In recent years, we have carried out high-resolution esophageal manometry and 24-hour pH/impedance monitoring for patients with interstitial pneumonia and pulmonary fibrosis suspected to be caused by gastroesophageal acid reflux. We can better assess the correlation between gastroesophageal reflux and pulmonary fibrosis, and to provide the different clinical treatments and even surgical interventions. The Bravo capsule is used more often in the United States, and it has obvious advantages over traditional approach for acid measurement. We strongly call for the collaboration between industry and academic institutions in this field, and the development of our own related products with independent intellectual property rights.

The overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

RNF20, an E3 ligase critical for monoubiquitination of histone H2B at lysine 120 (H2Bub), has been implicated in the regulation of various cellar processes; however, its physiological roles in adipocytes remain poorly characterized. Here, we report that the adipocyte-specific knockout of Rnf20 (ASKO) in mice led to progressive fat loss, organomegaly and hyperinsulinemia. Despite signs of hyperinsulinemia, normal insulin sensitivity and improved glucose tolerance were observed in the young and aged CD-fed ASKO mice. In addition, high-fat diet-fed ASKO mice developed severe liver steatosis. Moreover, we observed that the ASKO mice were extremely sensitive to a cold environment due to decreased expression levels of brown adipose tissue (BAT) selective genes, including uncoupling protein 1 (Ucp1), and impaired mitochondrial functions. Significantly decreased levels of peroxisome proliferator-activated receptor gamma (Pparγ) were observed in the gonadal white adipose tissues (gWAT) from the ASKO mice, suggesting that Rnf20 regulates adipogenesis, at least in part, through Pparγ. Rosiglitazone-treated ASKO mice exhibited increased fat mass compared to that of the non-treated ASKO mice. Collectively, our results illustrate the critical role of RNF20 in control of white and brown adipose tissue development and physiological function.

Traditional Chinese medicine (TCM) formulas have attracted increasing attention worldwide in the past few years for treating complex disease including rheumatoid arthritis. However, their mechanisms are complex and remain unclear. Guan-Jie-Kang (GJK), a prescription modified from "Wu Tou Decoction," was found to significantly relieve arthritis symptoms in rats with adjuvant-induced arthritis after 30-day treatment, especially in the 24 g/kg/day group. By analyzing 1749 targets related to 358 compounds in the five herbs of GJK, we identified the possible anti-arthritis pathways of GJK, including the calcium signaling and metabolic pathways. Bone damage levels were assessed by micro-computed tomography, and greater bone protective effect was observed with GJK treatment than with methotrexate. Receptor activator of nuclear factor κB ligand (RANKL)-RANK signaling, which is related to calcium signaling, was significantly regulated by GJK. Moreover, a target metabolomics assay of serum was conducted; 17 metabolic biomarkers showed significant correlations with treatment. An integrated pathway analysis revealed that pyruvate metabolism, purine metabolism, and glycolysis metabolism were significantly associated with the effects of GJK in arthritis treatment. Thus, this study establishes a new omics analytical method integrated with bioinformatics analysis for elucidating the multi-pathway mechanisms of TCM.

Objective To study the effect of exosomes ( EXs) released from high expression of miR-132-3p mesenchymal stem cells (MSCs) on hypoxia/reoxygenation (H/R) injured endothelial cell function. Methods MSCs extracted from bone marrow of C57BL/6 mice were cultured primarily. MSCmiR-132-3p was obtained from MSCs infected with lentivirus loaded with miR-132-3p vector. At the same time,MSCNC was obtained by infecting MSCs with control lentivirus loaded with scramble sequence. EXs released from MSCNCand MSCmiR-132-3pwas isolated,and MSC-EXs and MSC-EXsmiR-132-3pwere obtained respectively. The obtained EXs and H/R damaged mouse brain microvascular endothelial cells (bend3) were co-cultured. According to culture conditions,the cells were divided into normal culture group (normal cell culture),H/R group (making a H/R model),MSC-EXs group (MSC-EXs co-culture),MSC-EXsmiR-132-3p group (MSC-EXsmiR-132-3pco-culture), and MSC-EXsmiR-132-3p+ LY294002 group ( before the cells and MSC-EXsmiR-132-3pwere co-cultured,treated by adding phosphatidyl alcohol 3 kinase [ PI3K] signaling pathway blocker LY294002 [20 μmol/L]). Quantitative real-time quantitative polymerase chain reaction was used to detect the expression of miR-132-3p in MSCs,MSC-EXs,and bend3 cells. Angiogenesis kit was used to detect angiogenic ability of bend3 cells,and 3-(4,5-dimethylthiazole-2)-2,5-diphenyltetrazolium bromide (MTT) assay was used to detect the proliferative capacity of bend3 cells. Scratch test was used to detect the migration ability of bend3 cells. hochest33258 staining showed cell apoptosis. Western blot was used to detect the phosphorylation level of protein kinase B ( Akt) . Results Compared with the H/R group, the MSC-EXs treatment group significantly improved the angiogenesis,proliferation,migration abilities, and Akt phosphorylation level of bend 3 cell damage induced by H/R (The H/R group were 3 ± 1,0. 275 ± 0. 020,147 ± 8 μm,and 0. 89 ± 0. 12,respectively;the MSC-EXs treatment group were 8 ± 3,0. 358 ± 0. 030,218 ± 10 μm, and 1. 37 ± 0. 25 μm,respectively;all P<0. 01). Apoptosis was significantly reduced (47 ± 2% vs. 63 ± 2%,all P<0. 01). Compared with the MSC-EXs treatment group,the angiogenesis,proliferation,migration abilities,and Akt phosphorylation level of bend 3 cells in the MSC-EXsmiR-132-3ptreatment group were increased (14 ±3,0. 444 ± 0.050,357±10μm,and1.67±0.23,respectively,all P<0.01).Apoptosis was significantly reduced (34±1%,all P<0. 01) . Compared with the MSC-EXsmiR-132-3ptreatment group, cell proliferation, migration, angiogenesis abilities,and Akt phosphorylation level in the MSC-EXsmiR-132-3p+LY294002 group were significantly reduced (5 ± 2,0. 304 ± 0. 050,175 ± 8 μm and 0. 95 ± 0. 11,respectively,all P<0. 01). Conclusion MSC-EXs with high expression of miR-132-3p may improve many physiological functions of H/R-induced damaged cerebrovascular endothelial cells by activating PI3K/Akt signaling pathway.

Objective To explore the effect of standing at a table while training on the upper limb function and muscle surface electromyography of hemiplegics.Methods Sixty hemiplegic persons were randomly divided into an experimental group and a control group,each of 30.The affected upper limbs of the experimental group were trained while standing at a table,while the control group was trained while sitting.Before the treatment,as well as after 2 and 4 weeks of treatment,both groups' motor functioning was evaluated using the Fugl-Mayer upper limb assessment (FMA),as well as muscle surface electromyography.Results Before the treatment there was no significant difference betweenthe two groups' average FMA scores.After 2 and 4 weeks of treatment it had increased significantly in the experimental group,but in the control group the increase was not significant until the fourth week.In terms of surface myography,significant differences were observed in the biceps femoris and gastrocnemius muscles of both groups after 2 weeks.Two weeks later there was further significant improvement in both groups except for the tibialis anterior muscles of the control group.The differences between the two groups were significant after two weeks in the electromyograms of the biceps femoris,gastrocnemius muscle and anterior tibialis.After four weeks the differences between the groups in all of the electromyograms were significant.Conclusion Compared with the traditional sitting position,standing at a table while training can effectively improve the muscle activity of the rectus abdominis and the spine so as to promote the recovery of movement in hemiplegic upper limbs.

Objective To discuss the treatment effect and application value of salmon calcitonin nasal spray in the patients with postmenopausal osteoporosis.Methods 130 patients with postmenopausal osteoporosis were divided into observation group and control group by random number method,65 cases in each group.The control group was given calcium and alfacalcidol treatment,the observation group received in combination with salmon calcitonin nasal spray treatment.The clinical effect of the two groups was recorded.Results The total effective rate of the treat-ment group was 95.38%,which of the control group was 84.62%,the difference between the two groups was statisti-cally significant (χ2 =4.188,P<0.05 ).After treatment,the tuberosity bone mineral density,femoral neck BMD, L1 -4 lumbar spine bone mineral density of the observation group were (0.69 ±0.15)g/cm2,(0.77 ±0.21)g/cm2, (0.98 ±0.26)g/cm2,which of the control group were (0.52 ±0.08)g/cm2,(0.64 ±0.13)g/cm2,(0.81 ± 0.15)g/cm2,the differences between the two groups were statistically significant (t=8.062,4.243,4.566,all P<0.05).After treatment,the calcitonin,beta collagen fragment,osteocalcin of the observation group were (2.97 ± 0.86)ng/L,(0.11 ±0.01)ng/mL,(7.18 ±1.14)ng/mL,which of the control group were (2.41 ±0.43)ng/L, (0.35 ±0.08)ng/mL,(15.89 ±3.53)ng/mL,the differences between the two groups were statistically significant (t=4.695,24.000,18.930,all P<0.05).Conclusion Salmon calcitonin nasal spray in the treatment of patients with postmenopausal osteoporosis can reduce pain,inhibit osteoclast activity,promote bone formation,prevent bone loss and increase bone mass,it is safe and worthy of popularizing in clinical application.

Objective To investigate the relationship between the onset of lower extremity venous thrombotic disease and seasons.Methods A retrospective study was conducted, 300 patients with lower extremity venous thrombotic disease admitted to HandanCity Hospital of Traditional Chinese Medicine (TCM) from August 2012 to February 2014 were enrolled, the incidences and TCM syndromes of patients with lower extremity venous thrombotic disease in different seasons were observed, and the pathogenesis and relationships between the types of TCM syndrome and seasons were analyzed.Results There were 142 patients with lower extremity superficial thrombophlebitis, and 158 cases with lower extremity deep venous thrombosis, the incidence of lower extremity venous thrombotic disease in spring was significantly higher than that in summer and autumn [32.8% (86/262) vs. 21.3% (54/254), 18.4% (50/272), bothP < 0.01], but lower than that in winter [32.8% (86/262) vs. 37.2% (110/296)], the difference was not statistically significant (P > 0.01); while the incidence of lower extremity venous thrombotic disease in winter was significant higher than those in summer and autumn (allP < 0.01). The incidences of damp and heat downward flow type in autumn and summer were increased compared with those in winter and spring [55.6% (30/54), 60.0% (30/50) vs. 20.0% (22/110), 23.3% (20/86), allP < 0.01], while the incidences of lower extremity venous thrombotic disease with damp heat and stasis syndrome in winter and spring were increased compared with those in summer and autumn seasons [80.0% (88/110), 76.7% (66/86) vs. 44.4% (24/54), 40.0% (20/50)].Conclusions The incidence of lower extremity venous thrombotic disease is related to seasons, and the onset is high in winter and spring, damp heat and stasis syndrome being the main type; according to different seasons, clinical treatment can direct to different pathogenic factors to adopt different preventive measures interfering with the patient's constitution in order to eliminate or reduce the risk factors, achieving the effect of the disease prevention.

This study was aimed to summarize the clinical medication rule of professor Shi Qi in the treatment of cervical spondylosis of vertebral artery type (CSA),in order to explore the academic ideas.A total of 265 CSA cases from professor Shi Qi's outpatient clinic were collected in Longhua Hospital from 2009 to 2015.Frequency analysis and cluster analysis were conducted on used herbal medicine from included cases by SPSS 21.00 software.The results showed that there were a total of 202 types of herbs used.The five most commonly used herbs were Rhizoma Ligustici Wallichii,Radix bupleuri,Radix Achyranthis Bidentatae,Codonopsis and Gastrodia elata.The cluster analysis revealed that professor Shi Qi frequently used Huo-Xue Hua-Yu herbs,Bu-Xu herbs,Ping-Gan Xi-Feng herbs,Qu-Feng-Shi herbs.Sheng-Yu decoction and Tian-Ma Gou-Teng decoction were the core prescriptions used by professor Shi Qi in the treatment of CSA.It was concluded that the cluster analysis showed that academic ideas of professor She in the treatment of CSA was to pay equal attention to both qi and blood,to focus on liver and kidney,as well as to remove phlegm and blood stagnation,to treat both the branch and the root.The cluster analysis revealed a certain medication rule of professor Shi Qi in the treatment of CSA.It can be used as guidance in the clinical practice.

Objective To explore the correlations of diffusion-weighted imaging (DWI) types and the degree of neurologic impairment in acute ischemic stroke patients with atrial fibrillation.Methods DWI images and National Institutes of Health Stroke Scale(NIHSS) of 186 patients with acute ischemic stroke patients with atrial fibrillation were collected retrospectively.The correlation of DWI features and NIHSS was analyzed.Results On DWI,all acute ischemic stroke patients with atrial fibrillation presented high signal intensity.Single cortex-subcortical infarction mostly appeared in the anterior circulation(94,50.5%);Multi-infarction commonly occurred in the posterior circulation(18,13.0%);The neurological deficit scores of subcortical-cortex infarction in the left anterior circulation(16.75±7.10) were higher than that in the right side(13.50±5.70)(P<0.05).The neurological deficit scores of cortex-subcortical infarction in the posterior circulation (6.38±2.03) were significantly lower than that in the multi-infarction (16.77±8.90) (P<0.05).Conclusion DWI types are valuable for etiological diagnosis in ischemic stroke.Combination with NIHSS score could provide a basis for clinical individual treatment programs selection and prognostic evaluation.