OBJECTIVE To investigate the regulatory effects of couplet medicinals of Atractylodes macrocephala-Aucklandia lappa on gut microbiota and short-chain fatty acids （SCFAs） in the diarrhea-type irritable bowel syndrome （IBS-D） rats with spleen deficiency. METHODS The IBS-D rat model with spleen deficiency was induced by intragastric administration of Senna alexandrina combined with restraint stimulation. The model rats were divided into model group， positive control group （pinaverium bromide 1.5 mg/kg）， A. macrocephala-A. lappa low-dose， medium-dose and high-dose groups （0.7， 1.4， 2.8 g/kg）， with 6 rats in each group. Another 6 healthy rats were taken as the blank control group. The blank control group and the model group were given normal saline intragastrically， and other groups were given relevant drug liquid intragastrically， once a day， for consecutive 14 days. The general characteristics of rats and fecal water content were observed， and intestinal sensitivity [evaluating by abdominal wall withdrawal reflex （AWR） threshold] and the intestinal propulsion rate were determined. The serum levels of 5- hydroxytryptamine（5-HT）and SP were detected， and the pathological changes of colon tissue were observed； the protein expressions of 5-HT-3 receptor（5-HT3R）， 5-HT4R and 5-HT transporter（SERT） in colon tissue of rats were detected. 16S rRNA sequencing was performed for the feces of rats in blank control group， model group and A. macrocephala-A. lappa high-dose group； the contents of acetic acid， propionic acid and butyric acid in the feces of the rats were determined. RESULTS Compared with the model group， the body weight after 7 and 14 days of medication， fecal water content， AWR threshold， and the protein expressions of 5-HT4R and SERT in colon tissue were increased significantly in the A. macrocephala-A. lappa medium-dose and high-dose groups （P＜0.05 or P＜0.01）； serum contents of 5-HT and SP， intestinal propulsion rate （except for A. macrocephala-A. lappa medium-dose group）， the protein expression of 5-HT3R in colon tissue were decreased significantly （P＜0.01）； diarrhea relief， mental state recovery， and partially recovery of the structure of colon tissue were all found； moreover， the diversity and species number of gut microbiota were reduced in A. macrocephala-A. lappa high-dose group and the content of butyric acid in fecal samples was significantly reduced （P＜0.05）. CONCLUSIONS The compatibility of A. macrocephala and A. lappa can improve intestinal motility and sensitivity of IBS-D model rats with spleen deficiency， and alleviate diarrhea. This may be related to improving changes in intestinal microbiota structure， reducing 5-HT expression and butyric acid content， and increasing 5-HT4R and SERT expression.

Objective:To explore the clinical features and genetic etiology of a child with Char syndrome.Methods:A child who was presented at the Department of Child Health, Henan Children′s Hospital in February 2022 was selected as the study subject. Clinical data of the child was collected, and peripheral blood samples of the child and her parents were collected for the extraction of genomic DNA. Whole exome sequencing was carried out, and candidate variants were verified by Sanger sequencing and bioinformatic analysis.Results:The child had mainly manifested facial dysmorphism, patent ductus arteriosus, growth retardation, curving of fifth fingers and middle toes. Whole exome sequencing revealed that she has harbored a heterozygous c. 944A>C (p.Glu315Ala) variant of the TFAP2B gene, which was verified to be de novo by Sanger sequencing. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), the variant was rated to be likely pathogenic (PM1+ PM2_Supporting+ PM6+ PP3). Conclusion:The heterozygous c. 944A>C (p.Glu315Ala) variant of the TFAP2B gene probably underlay the Char syndrome in this child. Above finding has expanded the mutational and phenotypic spectra of the TFAP2B gene, which has facilitated early identification and diagnosis of Char syndrome.

Objective:To analyze the predictive value of CT coronary flow reserve fraction (CT-FFR) combined with coronary angiography in major adverse cardiovascular events (MACE) in patients with unstable angina pectoris (UAP).Methods:A total of 106 UAP patients treated in Wuhan Huangpi District People′s Hospital/Huangpi District People′s Hospital Affiliated to Jianghan University from April 2021 to April 2023 were retrospectively selected, among which 8 cases were lost to follow-up, and a total of 98 cases finally completed follow-up, and the occurrence of MACE within 1 year was counted, and they were classified into the MACE group (21 cases) and the non-MACE group (77 cases) according to whether or not MACE occurred. The general data, stenosis rate, CT-FFR and coronary plaque characteristics of the two groups were analyzed, and the correlation between each parameter index and B-type brain natriuretic peptide (BNP), Canadian angina pectoris (CCS) grade and the number of diseased vessels were analyzed. The predictive value was analyzed by receiver operating characteristic(ROC) curve, and the relationship between each parameter and the occurrence of MACE was analyzed by Logistic.Results:There were statistical differences in BNP, CCS and the number of diseased vessels between the two groups ( P<0.05). The total plaque volume, stenosis rate, calcified plaque volume and plaque load in the MACE group were higher than those in the non-MACE group, the CT-FFR value was lower than that in the non-MACE group: (142.56 ± 18.94) mm 3 vs. (132.78 ± 15.43) mm 3, (68.22 ± 10.78)% vs. (58.42 ± 9.14)%, (9.35 ± 1.85) mm 3 vs. (8.05 ± 2.02) mm 3, 0.75 ± 0.15 vs. 0.62 ± 0.11, 0.68 ± 0.10 vs. 0.84 ± 0.08, there were statistical differences ( P<0.05); the parameters above mentioned were closely correlated with CCS grade and the number of diseased vessels ( P<0.05). The results of ROC curve analysis showed that the area under the curve of MACE in UAP patients predicted by the combination of all parameters was 0.925, the sensitivity and specificity were 90.48% and 83.12%.The results of Logistic analysis showed that the stenosis rate, CT-FFR value, plaque volume, plaque load and calcified plaque volume were the risk factors for the occurrence of MACE in UAP patients ( P<0.05). Conclusions:The CT-FFR, stenosis rate and coronary plaque characteristics are different in UAP patients, and the combination of these parameters has certain clinical value in predicting the occurrence of MACE in patients.

ObjectiveTo investigate the effect and mechanism of Aconiti Lateralis Radix Praeparata-Cinnamomi Cortex in regulating the intestinal function in the rat model of slow transit constipation （STC） due to yang deficiency via the vasoactive intestinal peptide （VIP）/cathelicidin antimicrobial peptide （cAMP）/protein kinase A （PKA）/aquaporin （AQP） pathway. MethodSD rats were randomized into 6 groups （n=6）， including a control group， a model group， high-， medium-， and low-dose Aconiti Lateralis Radix Praeparata-Cinnamomi Cortex groups， and a prucalopride group. Other groups except the control group were treated with loperamide hydrochloride combined with ice water by gavage for the modeling of STC due to yang deficiency. The number of fecal pellets， time to the first black stool defecation， fecal water content， intestinal propulsion rate， and score of fecal properties were recorded in each group. At the end of the treatment， the colon was stained with hematoxylin-eosin （HE） to reveal the histopathological changes and Alcian blue/periodic acid-Schiff （AB-PAS） to reveal the secretion of colonic mucus. The enzyme-linked immunosorbent assay （ELISA） was employed to measure the level of VIP in the serum. The mRNA level of AQP in the colon was measured by polymerase chain reaction （Real-time PCR）. Immunohistochemical staining was performed to observe the expression of AQPs in the colon and kidney tissues. Western blot was performed to determine the protein levels of cAMP， PKA， and VIP in the colon tissue. ResultCompared with the control group, the model group had longer time to the first black stool defecation, reduced fecal pellets and water content, reduced Bristol Stool Form Scale score and intestinal propulsion rate, and constipation aggravated（P<0.01）. Moreover, increased the intestinal lesions, reduced the mucus secretion, reduce the serum VIP level, up-regulated the expression levels of AQP1 in the colon and kidney tissues, inhibited the expression of AQP3 and AQP9（P<0.01）., and down-regulated the protein levels of cAMP, PKA, and VIP in the colon tissue. Compared with the model group， the high-dose Aconiti Lateralis Radix Praeparata-Cinnamomi Cortex group had shortened time to the first black stool defecation， increased fecal pellets and water content， increased Bristol Stool Form Scale score and intestinal propulsion rate， and alleviated constipation symptoms. Moreover， high-dose Aconiti Lateralis Radix Praeparata-Cinnamomi Cortex reduced the intestinal lesions， increased the mucus secretion， elevated the serum VIP level（P<0.01）.， down-regulated the expression levels of AQP1 in the colon and kidney tissues， promoted the expression of AQP3 and AQP9（P<0.05，P<0.01）， and up-regulated the protein levels of cAMP， PKA， and VIP in the colon tissue. The medium- and low-dose groups had weaker effect than the high-dose group（P<0.01）. ConclusionHigh-dose Aconiti Lateralis Radix Praeparata-Cinnamomi Cortex can improve the intestinal motility and balance the intestinal water and fluid metabolism by up-regulating the VIP/cAMP/PKA/AQP pathway， thereby mitigating the constipation symptoms in the rat model of slow transit constipation due to yang deficiency.

Objective To investigate correlation between QT interval(QT),corrected QT interval(QTc) and metabolic syndrome(MS). Methods Residents who participated in our survey concerning atherosclerosis and related diseases conducted in Shenyang were included. They accomplished questionnaire,physical examination, laboratory tests and electrocardiography test. We divided them into MS group and non-metabolic syndrome (NMS)group according to International Diabetes Federation(IDF)diagnostic criteria for MS. QT interval was measured from the standard 12-lead electrocardiogram. QTc was calculated by using Bazett and Fridericia equations. We analyze correlation of QT ,QTc and MS. Results A total of 739 residents who were 35~64 years old were included. Individuals with MS had longer QTcB and QTcF than NMS group[(415.8 ± 31.9)ms vs.(410.1 ± 32.1)ms, (407.2± 29.1)ms vs.(402.6 ± 28.8)ms,P<0.05]. The more the number of abnormal MS parameters they had, the longer the QT,QTcB and QTcF they had. Regression analysis showed that QT was associated with serum potassium,smoking,blood glucose,and LDL,and QTcB and QTcF were associated with hypertension,waist circumference and blood potassium. Conclusions MS is associated with corrected QTc. Careful ECG monitoring among persons with MS for early detection of a long corrected QT interval may prevent severe and often fatal arrhythmias or sudden death.

BACKGROUND: Most of evidence-based studies include both adult degenerative scoliosis and adult idiopathic scoliosis, which lead to indirectness in the results, and suppress the promotion of the evidence.OBJECTIVE: To systematically analyze the current clinical researches, and to review the curative efficacy of lateral lumbar interbody fusion for adult degenerative scoliosis.METHODS: A computer-based research of Medline, EMBASE, CENTRAL, WanFang and CNKI databases from December 2015 to December 2016, was performed with the key words of lateral lumbar interbody fusion, direct lumbar interbody fusion, extreme lateral interbody fusion, minimal invasive surgery, adult scoliosis. The articles were screened based on the inclusion criteria, and the clinical symptom improvement and radiological changes were analyzed.RESULTS AND CONCLUSION: Totally 13 articles were included. In the treatment of adult degenerative scoliosis, lateral lumbar interbody fusion shows less blood loss, short hospitalization time, significantly improved symptoms, satisfactory correction at the coronal plane, and low incidence of long-term complications. However, it has the poor correction at the sagittal plane and high incidence of short-term postoperative complications. Therefore, intraoperative neurologic monitoring is necessary and the combination with internal fixation has obtained good effectiveness.

Objective To study the independent risk factors of relapse of smoking among current smokers of different ages who underwent percuta?neous coronary intervention(PCI). Methods Totally 197 current smokers who received PCI from January 2007 to December 2009 in the Fourth Affiliated Hospital of China Medical University were enrolled. Information about relapse of smoking was collected through the medical records and the telephone follow?up. Discrepancy of risk factors of smoking resumption was compared in different age groups. Results Totally 112 patients re?sumed smoking after PCI. There were 87 patients in the non?elderly group and 25 in the elderly group. According to the correlation analysis,more than one stents(P=0.025),severe nicotine dependence(P=0.001)and long time for daily passive smoking(P=0.000)were related with relapse in the non?elderly group,and there was a negative correlation between more than one stents and relapse. But in the elderly group,relapse was associ?ated with history of hypertension(P=0.034). According to the logistic regression analysis in different age groups,independent predictors of smoking relapse in the non?elderly group were severe nicotine dependence(OR:3.914,P=0.003)and long time for daily passive smoking(OR:1.352,P=0.000). And in the elderly group,independent risk factors of smoking relapse were male(OR:17.325,P=0.027),history of hypertension(OR:13.185,P=0.005),long time for daily passive smoking(OR:1.273,P=0.045)Conclusion Independent risk factors of smoking relapse were different in the elderly group and the non?elderly group. In the non?elderly group,these factors were severe nicotine dependence and long time for dai?ly passive smoking. And in elderly group,these factors were male,history of hypertension,long time for daily passive smoking.

Objective:To study the relationship between neutrophil to lymphocyte ratio (N/L) and traditional cardio‐vascular risk factors among community 35~64‐year‐old residents .Methods :A total of 1884 residents (548 males and 1336 females) from urban Shenyang city received baseline condition questionnaire on cardiovascular diseases and re‐lated diseases from Apr 2011 to Feb 2012. According to presence of cardiovascular risk factors or not ,subjects were divided into healthy control group (n=675) and risk factor group (n=1209);according to number of risk factors , risk factor group was further divided into one risk factor group (n=491) ,two risk factors group (n=263) and ≥3 risk factors group (n=455) .Morning blood sample and urine sample were retained to measure blood and urine rou‐tine ,blood glucose and blood lipid profile etc in all subjects .N/L was compared and analyzed among all groups .Re‐sults:Among patients with only one of following risk factors [hypertension ,diabetes mellitus (DM) ,dyslipidemia and obesity] ,N/L levels of patients with hypertension or DM were significantly higher than that of healthy control group [1.55(1.15 ,1.95) ,1.60(1.21 ,2.07) vs .1.45(1.09 ,1.91)] , P<0.05 both ,and there were no significant difference between any other one risk factor group and healthy control group , P>0.05 all .Among risk factor sub‐groups ,N/L level of ≥3 risk factors group was significantly higher than that of two risk factors group [1.57(1.16 , 2.04) vs .1.41(1.07 ,1.89) ,P<0.05] ,and there was no significant difference between any other two groups (P>0.05) .Conclusion:N/L significantly related to hypertension or DM ,and N/L level of ≥3 risk factors group was sig‐nificantly higher than that of two risk factors group ,N/L is helpful to assess risk of cardiovascular diseases .

Objective To explore effect of irregular chemotatic factor fractalkine(FKN),phosphatidyl inositol 3 kinase and nuclear factor?κB(NF?κB)on interleukin?6(IL?6)expression in peripheral blood monocytes and the effect of valsartan intervention,so as to research the signal conduc?tive mechanism of FKN impacting on IL?6. Methods Peripheral blood monocytes were isolated from fresh blood of healthy volunteers by the densi?ty gradient centrifugation. The extractive peripheral blood monocytes were divided into seven groups:the control group,the FKN group,the LY294002 group(PI3K inhibitors),the PDTC group(NF?κB inhibitors),the FKN+valsartan group,the FKN+LY294002 group,and the FKN+PDTC group,the latter two were pretreated by LY294002 and PDTC respectively before FKN inducing PBMC cells. The IL?6 expression in cell me?dium was measured in each group by ELISA at 12 hours and 24 hours after PBMC treatment. Results After 12 hours of culture,compared with the control group,the expression of IL?6 in the FKN group was decreased(P<0.05),while LY294002 and PDTC groups had no significant difference (P>0.05). Compared with the FKN group,the expression of IL?6 was decreased in the FKN+valsartan group(P<0.05),increased in the FKN+LY294002 group(P<0.05),and was decreased in the FKN+PDTC group(P<0.05). After 24 hours of culture,the IL?6 expression in each group had no significant difference(P>0.05). Conclusion FKN can adjust the expression of peripheral blood PBMC IL?6 in a two?way pattern, inhibiting the expression of IL?6 by PI3K pathway and promoting the expression of IL?6 by NF?κB pathway,overall,FKN can inhibit the expression of IL?6. Valsartan can increase FKN to inhibit the expression of IL?6.

Objective The incidence rate of acute pancreatitis in pregnancy (APIP) is on the rise, and yet there is no effec-tive method for its prevention and treatment .This study aimed to investigate the high risk factors of APIP and its prognostic evaluation index. Methods We retrospectively analyzed the clinical data of 35 cases of APIP ( group A) and another 35 cases of acute pancre-atitis in non-pregnancy as controls (group B).We compared the etiologic factors of acute pancreatitis , changes of laboratory indexes after onset of the disease , and clinical outcomes between the two groups . Results No statistically significant differences were found in the risk factors between the two groups (χ2 =0.233, P>0.05).Serum cholesterol and triglyceride levels were remarkably higher in group A ([15.69 ±7.71] and [15.54 ±7.82] mol) than in B ([5.07 ±2.95] and [3.82 ±2.58] mol) (P<0.05).There were significant differences between groups A and B in WBC count ([19.00 ±5.31] vs [14.98 ±9.77] 109/L), Hb ([82.77 ±11.77] vs [101.77 ±1.50] g/L), and serum Glu ([8.77 ±2.76] vs [6.23 ±1.99] mol/L)(P<0.05).Multivariate logistic regression a-nalysis showed the predictive value of cholesterol and triglyceride levels for APIP and a correlation of WBC and Hb with the clinical out -comes of the patients.The in-hospital mortality rate was significantly higher in group A than in B (χ2 =3.968, P=0.046), and so was the incidence rate of severe acute pancreatitis (χ2 =5.510, P=0.019). Conclusion Biliary diseases are the main high risk factors of APIP, followed by hyperlipidemia .Triglyceride and cholesterol levels have the predictive value for APIP .The WBC count and Hb level can be used to assess the patients′condition and predict the clinical outcomes .