Abstract:Objective To investigate the regulating effects and mechanism of microRNA (miRNA)-141 on bone morphogenetic protein-2 (BMP-2)-induced calcification of human aortic valve. Methods Twenty-four samples of human degenerative aortic valve were collected, and the mRNA and protein expression levels of miRNA-141 and BMP-2 were detected by quantitative real-time polymerase chain reaction and Western blotting. miRNA-141 was up/down-regulated in human aortic valve interstitial cells (HAVICs), Von Kossa staining was used to show cellular calcification, and mRNA expression of distal-less homeobox 5 (Dlx5) and protein expression of BMP-2 were compared. Dual luciferase experiment was used to verify whether Dlx5 was the target gene of miRNA-141. miRNA-141 was up/down-regulated in aortic valve calcification mouse models with or without Dlx5 knockout, Von Kossa staining was used to compare aortic valve calcification, and BMP-2 protein expression was detected. Results Compared with normal aortic valve tissues, the expression of miRNA-141 was significantly decreased in degenerative aortic valves (1.00±0.02 vs 0.35±0.06, P=0.01), while the mRNA and protein expression levels of BMP-2 were significantly increased (both P=0.01). In HAVICs, the up/down regulation of miRNA-141 could inhibit/promote calcification (P=0.02 or P=0.01), and decrease/increase the mRNA expression of Dlx5 (both P=0.01) and the protein expression of BMP-2 (P=0.02 or P=0.01). Dual luciferase experiment validated that miRNA-141 directly targeted Dlx5. In aortic valve calcification mouse model, up/down-regulation of miRNA-141 could inhibit/promote calcification (both P<0.05), and decrease/increase the mRNA and protein expression levels of Dlx5 and BMP-2 (all P<0.05); while in mouse model with Dlx5 knockout, there were no correlation between miRNA-141 expression and valvular calcification or BMP-2 expression. Conclusion miRNA-141 can inhibit human aortic valve calcification via regulating BMP-2 by targeting Dlx5.

Abstract:Objective To elucidate the role and mechanisms of inhibiting Ca²⁺/calmodulin-dependent protein kinase Ⅱ (CaMK Ⅱ) in cardiac hypertrophy and apoptosis in pressure overload-induced heart failure mice. Methods Twenty-four male C57BL/6 mice aged 6-8 weeks were evenly randomized into four groups:sham operation group, sham operation+ KN-93 group, transverse aortic constriction (TAC) group, and TAC+KN-93 group. The body and heart weights of mice in each group were recorded, and the heart weight index (HWI) was calculated; the geometry and function of mouse heart were evaluated by echocardiography; the cross-sectional area, fibrosis degree and apoptosis level of mouse cardiomyocytes were detected by triticum vulgaris lectin (WGA), Masson's trichrome and TUNEL staining, respectively. The mRNA expression of atrial natriuretic peptide (ANP) was determined by qRT-PCR; Western blotting was used to detect the protein expression of ANP, brain natriuretic peptide (BNP), β-myosin heavy chain (β-MHC), cleaved Caspase 3, cleaved Caspase 9, B-cell lymphoma-2 (Bcl-2), B-cell lymphoma-2-related X protein (Bax), phosphorylated-Ca²⁺/calmodulin-dependent protein kinase Ⅱ (p-CaMKⅡ) and sirtuin3 (Sirt3). Results The HWI, left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) were higher (all P<0.05), while the left ventricular ejection fraction (LVEF) and left ventricular fraction shortening (LVFS) were lower in TAC group compared with those in the sham group (both P<0.05). The cardiomyocyte cross-sectional area, the ANP mRNA level and the protein expressions of ANP, BNP, and β-MHC, and the myocardial fibrosis and cardiac apoptosis were significantly increased in TAC group compared with the sham group (all P<0.05). TAC group also had significantly increased protein expression of apoptosis-related proteins (cleaved Caspase 3, cleaved Caspase 9 and Bax) and decreased anti-apoptosis protein Bcl-2 compared with the sham group (all P<0.05); moreover, the ratio of p-CaMKⅡ/CaMKⅡ was decreased and the expression of Sirt3 was significantly increased in TAC group (both P<0.05). However, the above indexes were significantly reversed in TAC+KN-93 group compared with those in TAC group after the administration of KN-93, a CaMKⅡ inhibitor (all P<0.05). Conclusion Inhibition of CaMKⅡ can alleviate cardiac dysfunction and inhibit cardiac hypertrophy and apoptosis in pressure overload-induced heart failure mice by regulating Sirt3.

Abstract:Objective To explore the mechanism of ozone exposure-induced chronic rhinosinusitis by analyzing the alterations in the expression of oxidative stress-related genes in human nasal epithelium. Methods An in vitro cultured ozone exposure-induced human nasal epithelium model was established. The oxidative-stress-related genes of human nasal epithelium were detected by high-throughput polymerase chain reaction (PCR) chip before and after ozone exposure, and were verified by quantitative real-time polymerase chain reaction (qRT-PCR). The expressions of cyclooxygenase 2 (Cox2) and reactive oxide species (ROS) were detected by qRT-PCR, Western blotting and flow cytometry. Results A total of 84 oxidativestress-related genes were screened by PCR chip in the human nasal epithelium. It was found that the expression of aldo-keto reductase family 1 member C2 (AKR1C2), glutamate-cysteine ligase modifier subunit (GCLM), glutathione peroxidase 2 (GPX2), glutathione-disulfide reductase (GSR), heme oxygenase 1 (HMOX1), NADPH oxidase 5 (NOX5), prostaglandin-endoperoxide synthase 2 (PTGS2), superoxide dismutase 2 (SOD2), and serine peptidase inhibitor Kazal type 1 (SPINK1) was up-regulated after intensive ozone exposure, while the expression of C-C motif chemokine ligand 5 (CCL5), cytoglobin (CYGB), epoxide hydrolase 2 (EPHX2), glutathione S-transferase zeta 1 (GSTZ1), keratin 1 (KRT1), phospholysine phosphohistidine inorganic pyrophosphate phosphatase (LHPP), myoglobin (MB), mitochondrial inner membrane protein MpV17 (MPV17), selenoprotein P (SEPP1), and trafficking protein particle complex 6A (TRAPPC6A) was down-regulated. At the same time, ozone exposure resulted in a large amount of ROS (fluorescence intensity of the exposure group and control group:184.3±6.8 vs 13.0±1.4, P<0.05) and increased expressions of Cox2 mRNA and protein (relative expression of mRNAs:6.4±1.2 vs 1.0±0.0, P<0.05; relative protein expression:11.7±2.6 vs 13.8±1.5, P<0.05). Conclusion After ozone exposure, GSTZ1, NOX5, SOD2 and other related genes are involved in the regulation of oxidative stress in nasal epithelium. The inflammatory response of nasal epithelium induced by ozone exposure may be related to the signaling pathways of Cox2 expression that regulated by these genes.

Abstract:Objective To explore the molecular mechanism of methionine starvation induced apoptosis in gastric cancer cells. Methods The expression of programmed death ligand-1 (PD-L1) in gastric cancer tissues was analyzed by the cancer genome atlas (TCGA) database. The gastric cancer AGS cells and the gastric cancer cells treated with siRNA that inhibit the expression of PD-L1 (siPD-L1) were cultured with ordinary medium and methionine-starved medium. According to the treatment method, they were divided into control group, methionine starvation treatment group, siPD-L1 treatment group, and methionine starvation combined siPD-L1 treatment group. The cell viability of gastric cancer was detected by cell counting kit 8, the apoptosis of gastric cancer cells was detected by acridine orange/ethidium bromide double staining, and the apoptosis rate of gastric cancer cells was detected by flow cytometry. The expression levels of PD-L1, B-cell lymphoma-2 (Bcl-2), B-cell lymphoma-2-related X protein (Bax) and Caspase 3 were detected by Western blotting analysis. Finally, the relationship between PD-L1 and Bcl-2 anti-apoptotic protein family (Bcl-2 related protein A1[BCL2A1], myeloid cell leakemia 1[MCL1], BCL2, and Bcl-2 like 1[BCL2L1]) was analyzed by starBase database. Results PD-L1 was highly expressed in gastric cancer tissues (P<0.01), and the expression of PD-L1 was correlated with G grade of gastric cancer (P<0.01). Methionine starvation and siPD-L1 significantly decreased the survival rate of gastric cancer cells (P<0.01), promoted apoptosis (P<0.01), inhibited the expression of PD-L1 and Bcl-2 (P<0.05), and up-regulated the expression of proapoptotic proteins Bax and Caspase 3 (P<0.01). The effect of methionine starvation combined with siPD-L1 was even stronger (P<0.05). There was a positive correlation between PD-L1 and Bcl-2 anti-apoptotic protein family (P<0.01), indicating that PD-L1 is a key anti-apoptotic gene. Conclusion Methionine starvation can induce gastric cancer cell apoptosis by inhibiting the expression of PD-L1, downregulating the expression of anti-apoptotic protein Bcl-2 and up-regulating the expression of Bax and Caspase 3.

Abstract:Objective To investigate the expression and upstream/downstream mechanisms of ubiquitin fold modifier 1-specific peptidase domain protein (ZUP1) in breast cancer. Methods Gene information and clinicopathological data of breast cancer patients were retrieved using Gene Expression Omnibus (GEO), Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression (GTEx) databases. The relationships between the expression of ZUP1 and clinicopathological factors/survival status of breast cancer patients were analyzed by χ² test and Kaplan-Meier survival analysis, respectively. Bioinformatics methods were used for prediction of miRNAs and ubiquitin ligase that could potentially regulate ZUP1. Finally, the gene set enrichment analysis (GSEA) was performed. Results The expression of ZUP1 was higher in breast cancer tissues than in normal control tissues, and was related to T stage, PAM50 classification, statuses of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2, and histological type of breast cancer (all P<0.01). The overall survival time of patients with high expression of ZUP1 was significantly lower than that of patients with low expression of ZUP1 (P=0.031). Bioinformatics predicted that the top 10 miRNAs targeting ZUP1 with the highest differential expression were miRNA-10b-3p, miRNA-499a-5p, miRNA-181b-2-3p, miRNA-181b-3p, miRNA-4420, miRNA-548aw, miRNA-5680, miRNA-570-3p, miRNA-7156-5p and miRNA-8087. E3 ubiquitin ligase including MARCH1, MARCH8, Mdm2, synoviolin and MIB1 may regulate the expression of ZUP1. The GSEA results indicated that ZUP1 was mainly involved in basic transcription factor, ubiquitin mediated proteolysis, oocyte meiosis, RNA degradation and Aurora B pathway. Conclusion The expression of ZUP1 is up-regulated in breast cancer, and is related to prognosis. The upstream and downstream mechanisms of ZUP1 in the development and progression of breast cancer are related to a variety of miRNAs and multiple signaling pathways.

Abstract:Objective To evaluate the effect of ultrasound-guided transversus abdominis plane block (TAPB) combined with target-controlled infusion (TCI) of remifentanil in extracorporeal shock wave lithotripsy (ESWL) of pancreatic stones. Methods Sixty patients with pancreatic stones who received ESWL for the first time were randomly divided into R group and TR group (30 cases in each group). Patients in R group received TCI of remifentanil only, while patients in TR group received ultrasound-guided TAPB 30 min before TCI of remifentanil. Dixon's up-and-down method was used to calculate the half maximum effective concentration (EC₅₀) of remifentanil. Perioperativevisual analog scale (VAS), Ramsay sedation scale, hemodynamic parameters, respiratory parameters, and adverse events were also recorded. Results The EC₅₀ of remifentanil were 3.448 ng/mL (95% confidence interval[CI] 1.636-3.946 ng/mL) and 2.523 ng/mL (95% CI 0.744-2.991 ng/mL) in the R group and the TR group, respectively (P<0.05). The VAS score and the Ramsay sedation scale were comparable between the two groups (both P>0.05), and there were no significant differences in hemodynamics and respiratory parameters between the two groups (both P>0.05). Compared with the R group, the total incidence rate of adverse events was lower in the TR group (10.0%[3/30]vs 56.7%[17/30], P<0.001), and so was the incidence rate of itching (6.7%[2/30]vs 26.7%[8/30], P=0.038). Conclusion TAPB combined with TCI of remifentanil can provide satisfactory analgesia and sedation for ESWL of pancreatic stones, and can reduce the dosage of remifentanil, with less adverse events.

Abstract:Objective To investigate the effects of new-onset left bundle branch block (new-LBBB) on hemodynamics and prognosis after transcatheter aortic valve placement (TAVI). Methods The data of 245 severe aortic stenosis patients who underwent TAVI from Mar. 2013 to Apr. 2018 in the Second Affiliated Hospital, Zhejiang University were retrospectively analyzed. Patients were divided into control group (188 cases) and new-LBBB group (57 cases) based on whether they had new-LBBB or not after TAVI. The baseline data were collected at admission, and the echocardiographic results were analyzed at preoperation and 12 months postoperation. The study endpoint was all-cause death, and the follow-up deadline was Apr. 30, 2019. Survival analysis was performed by Kaplan-Meier method and log-rank test. Results There were no significant differences in mitral regurgitation score or left ventricular ejection fraction (LVEF) between the two groups before operation (both P>0.05); 12 months postoperation, the LVEF of the new-LBBB group was significantly lower than that of the control group (59.20%[53.70%, 64.58%]vs 64.90%[60.17%, 68.45%]), and the mitral regurgitation score was significantly higher than that of the control group (1.16[0.44, 1.84]vs 0.82[0.27, 1.46]) (Z=-4.267, -2.668, both P<0.01). After 35.77 (23.80-45.88) months of follow-up, the mortality rate of the new-LBBB group was 10.5% (6/57) and that of the control group was 5.9% (11/188), with no significant difference (χ²=1.48, P=0.238). Conclusion New-LBBB after TAVI can affect LVEF, induces or aggravates mitral regurgitation, but has no influence on 1-year survival rate.

Abstract:Objective To investigate the rate and the influencing factors of progression from impaired fasting glucose (IFG) to diabetes mellitus without drug intervention by continuous observation for 10 years in physical examination population. Methods A total of 557 people aged over 18 years who had physical examination in our hospital from 2008 to 2018 were included. The data of fasting blood glucose, blood pressure, total cholesterol and triglyceride were collected at every physical examination. The progression rate to diabetes mellitus in IFG patients diagnosed in 2008 and patients with normal fasting blood glucose progression to IFG were analyzed. Diabetes mellitus was defined as fasting blood glucose ≥ 7.0 mmol/L, or with a history of diabetes mellitus, or having been treated with insulin or oral hypoglycemic drugs; IFG was defined as no history of diabetes mellitus, receiving no hypoglycemic therapy, and fasting blood glucose being 5.6-6.9 mmol/L; normal fasting blood glucose was defined as no history of diabetes mellitus, receiving no hypoglycemic therapy, and fasting blood glucose <5.6 mmol/L. Binary logistic regression was used to analyze the influencing factors of progression from IFG to diabetes mellitus. Results There were 283 males and 274 females, aged 39 (19-69) years. Twenty-five cases (4.5%) were diagnosed with diabetes mellitus, 30 cases (5.4%) with IFG, and 502 cases with normal fasting blood glucose in 2008. In the 30 IFG cases, 14 (46.7%) cases progressed to diabetes mellitus within 10 years and 11 (36.7%) cases within 5 years. The proportion of patients with fatty liver (FL) and the level of triglyceride in the progressed group were higher than those in the non-progressed group within 5 years (both P<0.05). Among the 502 cases with normal fasting glucose in 2008, 177 cases progressed to IFG within 10 years, and 20 cases progressed to diabetes mellitus during the subsequent follow-up. The proportion of FL patients and triglyceride level in the progressed group were significantly higher than those in the nonprogressed group (both P<0.01). Binary logistic regression analysis showed that triglyceride was an independent risk factor for people with first diagnosis of IFG and then progressed to diabetes mellitus and those with normal initial fasting blood glucose and then progressed to IFG and further to diabetes mellitus (OR=2.43, 95% CI 1.03-5.70, P<0.05; OR=1.50, 95% CI 1.12-2.01, P<0.05). Conclusion IFG is an important stage of progression from normal fasting blood glucose to diabetes mellitus, and triglyceride is an independent risk factor for IFG to diabetes mellitus.

Abstract:Objective To analyze the clinical distribution and drug resistance of Pseudomonas aeruginosa (PA) in our hospital in recent 5 years, so as to provide basis for rational use of antibiotics, reduction of drug-resistant strains and prevention and control of nosocomial infections. Methods The PA data of inpatients in our hospital from 2015 to 2019 were retrospectively analyzed. The clinical distribution, sample sources and drug resistance rate of PA and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were statistically analyzed. Results A total of 1 822 PA strains were isolated from 1 571 inpatients in our hospital, including 550 CRPA strains (30.2%). The department with the highest isolation rate of PA and CRPA was the Burn Department (16.1%[293/1 822]and 17.8%[98/550]), followed by the Emergency Department (13.9%[254/1 822]and 14.7%[81/550]). The main types of PA and CRPA samples were sputum/bronchoalveolar lavage fluid (50.3%[916/1 822]and 61.8%[340/550]), followed by wound secretion (16.5%[300/1 822]and 10.5%[58/550]). The resistance rates of PA and CRPA to imipenem were the highest (23.4%[427/1 822]and 93.1%[512/550]), followed by meropenem (21.2%[387/1 822]and 83.8%[461/550]). Conclusion The isolation rates of PA and CRPA in our hospital is high. It is necessary to timely analyze the changes of clinical distribution and drug resistance rates of PA and CRPA, strengthen drug resistance monitoring, optimize rational clinical use of drugs and effectively prevent and control nosocomial infections.

Abstract:Drowning is an accidental injury factor with high disability and death rates. The disease progresses rapidly, and the victims are often in a critical condition. Moreover, due to the complex pathophysiological mechanism, the current treatment is very limited. As a special type of drowning, cold water immersion syndrome usually occurs immediately after the patient is immersed in cold water and runs through the whole process of drowning. It often leads to cardiac arrest and other critical situations, playing an important role in the occurrence and development of drowning. This article focuses on the pathophysiological mechanism of cold water immersion syndrome and summarizes its clinical diagnosis and treatment, so as to provide a theoretical basis for further clinical treatment.

Abstract:The prevalence of gestational diabetes mellitus (GDM) is on the rise in China, and the disease-related complications are also increasing. Medical nutrition treatment (MNT) plays an important role in the management of GDM. The primary objective of MNT is to maintain euglycemia, control gestational weight gain and ensure fetus growth while reducing the risks of complications and adverse pregnancy outcomes. The principles and methods of MNT have been gradually improved, but there are still controversies in the aspects of nutrient intake, carbohydrate intake ratio, micronutrient supplement and weight control. This article reviews the clinical application of MNT for GDM.

Abstract:Objective To investigate the mental health status of naval officers and soldiers and its influencing factors, and explore the mediating effect of negative automatic thoughts on the relationship between psychological stress and mental health. Methods A total of 642 naval officers and soldiers from a naval force were investigated with the psychological stress self-evaluation test (PSET), the automatic thoughts questionnaire (ATQ) and the symptom checklist 90 (SCL-90), and the relationships between the variables were analyzed. Results Altogether 583 valid questionnaires were collected, with an effective rate of 90.80%. Correlation analysis showed that the degree of psychological stress and negative automatic thoughts were positively correlated with mental health (total score of SCL-90) (both P<0.05). Regression analysis showed that the degree of psychological stress and negative automatic thoughts could predict the mental health status; the mediating effect of negative automatic thoughts between the degree of psychological stress and mental health was significant (accounting for 37.30% of the total effect), and there were significant differences in mental health status among officers, sergeants and conscripts (P<0.05). Conclusion The degree of psychological stress and the negative automatic thoughts are important factors affecting the mental health of naval officers and soldiers. The degree of psychological stress can directly or indirectly affect the mental health through the mediating effect of negative automatic thoughts.

Abstract:Objective To investigate and analyze the morbidity of military personnel stationed on an island-reef from Jun. 2018 to Oct. 2019, and to provide basis for medical and health support. Methods The outpatient registration information was extracted from the island-reef hospital. The medical records were classified according to ICD-10 and related catalog, and the causes of diseases were analyzed combined with relevant data. Results A total of 15 601 cases were collected in this study. The top five common diseases on the reef hospital included orthopedic diseases (3 140 cases), skin diseases (3 017 cases), oral diseases (2 623 cases), respiratory diseases (1 451 cases) and otorhinolaryngologic diseases (1 228 cases), and some of them such as stomatology, respiratory system diseases and other common diseases were significantly related to the season. The proportions of oral and respiratory diseases in July were 20.41% (361/1 769) and 15.49% (274/1 769), respectively, which were higher than other time of the year. The prevalence of systemic diseases in different age groups was different. Compared with those under the age of 50, the percentages of diseases of general medicine (mainly in rheumatism, blood, kidney and endocrine diseases) and cardiology significantly increased in patients older than 50 years old, being 10.00% (10/180) and 5.56% (18/180), respectively (P<0.05). Conclusion The morbidity of military personnel stationed on the island-reef has obvious epidemiological characteristics, with different disease spectra in different age groups, and the medical support should be given with pertinence.

Abstract:Objective To understand the job burnout and psychology defense style of Chinese soldiers during vital task, and to explore the correlation between job burnout and psychology defense style, so as to provide a theoretical basis for the intervention of job burnout in military. Methods A total of 226 soldiers were investigated by the military burnout inventory and defense style questionnaire (DSQ) when they participated in a major military training for 6 months. Results A total of 226 valid questionnaires were collected and the effective rate was 100%. The average total score of job burnout was 13.10±10.80, and the highest score (4.32±3.45) was for low self-evaluation among five factors of job burnout. The result of the Pearson correlation analysis showed that the total score of job burnout was not significantly correlated with fantasy, release or expectation, but was significantly correlated with all the other factors of defense style (all P<0.01). The result of the regression analysis found that mature defense style and immature defense style were significant factors of job burnout (both P<0.01); the higher the score of mature defense style, the lower the score of job burnout, and the higher the score of immature defense style, the higher the score of job burnout. Conclusion The job burnout of serviceman is related to their specific defense style, and the interventions can be taken accordingly.

Abstract:Objective To investigate whether the presence of polycystic kidney disease (PKD) increases the incidence of peritoneal dialysis-related peritonitis. Methods The clinical data of 249 patients who received continuous ambulatory peritoneal dialysis (CAPD) as renal replacement therapy in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 1, 2008 to Dec. 31, 2018 were collected and analyzed retrospectively. According to the type of primary disease, the patients were divided into PKD and non-PKD groups; they were divided into ≤ 62 and >62 years old groups. Dialysis time was calculated from the beginning to the end of CAPD. Poisson regression was performed to calculate the incidence of peritoneal dialysis-related peritonitis (episode/patient-year). The 95% confidence interval (CI) was obtained and hypothesis test was carried out after adjusting the age, gender and other covariates. Poisson regression analysis was performed for each group to calculate the attack time interval (months) and 95% CI. Results A total of 249 patients were enrolled in this study, including 14 PKD patients (5.62%) and 235 non-PKD patients (94.38%), 132 males (53.01%) and 117 females (46.99%), aged (62.31±14.82) years. The age of non-PKD and PKD patients were (62.33±15.07) and (62.57±10.01) years, respectively. The median duration of CAPD was 42.50 (1.00-137.70) and 55.35 (9.60-131.50) months, respectively. The overall incidence of peritonitis was similar in non-PKD and PKD patients (0.44 and 0.35 episode/patient-year, respectively), and the incidence of gram-negative bacterial peritonitis was same (both 0.09 episode/patient-year). Poisson regression analysis showed that gender, age or PKD had no significant effects on the incidence of peritoneal dialysis-related peritonitis. The time intervals for each episode of peritoneal dialysis-related peritonitis in non-PKD and PKD patients were 27.39 (95% CI 23.90-31.91) and 33.86 (95% CI 19.83-116.50) months, respectively. The time intervals for each episode of gram-negative bacterial peritonitis in non-PKD and PKD patients were 134.83 (95% CI 96.00-226.41) and 141.17 (95% CI 81.63-521.74) months, respectively. Conclusion PKD does not increase the risk of peritonitis in peritoneal dialysis patients.

Abstract:Objective To investigate the safety of etomidate speech and memory-Wada test (eSAM-Wada) and the efficacy of eSAM-Wada in the function assessment of motor, speech and memory. Methods The clinical data of five patients with intractable epilepsy who underwent eSAM-Wada in the Department of Neurosurgery, Shenzhen University General Hospital were retrospectively analyzed. During the procedures of digital subtraction angiography (DSA), 2 mg etomidate was administered intravenously after the microcatheter reached the target vessel, followed by 0.004 mg·kg^-1·min^-1 continuous intravenous pumping. The changes of motor, speech and memory functions and intraoperative adverse effects were observed. Results All the five patients completed the whole procedure of eSAM-Wada, and two patients completed eSAM-Wada under vascluar superselection. Of the five patients, three were left-handed and two were right-handed. Among the three left-handed patients, the speech dominant hemisphere was located in the left hemisphere in two patients, while the other two right-handed patients had their speech dominance in the left hemisphere. Four patients had extensive lesions in the left hemisphere. The dominant side of memory was located in the left temporal lobe in two cases, bilateral dominance in one case, and completely transfering to the right temporal lobe in one case. Two patients underwent subsequent resection and one patient underwent stereotactic electroencephalogram (SEEG)-guided thermocoagulation. One patient had transient postsurgical paralysis over the left extremities. The changes of motor, speech and memory functions for these patients were consistent with the results of eSAM-Wada. Two patients had seizures, which might be related to the rapid intravenous administration of etomidate in the procedure. After prolonging the administration time to >30 s, the remained two patients had no seizures. Conclusion eSAMWada is a reliable and relatively safe method for comprehensive evaluation of motor, speech and memory functions in epilepsy surgery. Combined with vascular superselective technology, it can provide more effective guidance for craniocerebral surgery involving functional areas.

Abstract:Objective To analyze the epidemiological characteristics and development trend of coronavirus disease 2019 (COVID-19), and to evaluate the impact of prevention and control measures on the epidemic in China and other countries, so as to provide a basis for further prediction of the epidemic development and formulation of targeted prevention and control measures. Methods The statistics of domestic epidemic situation released by the provincial and municipal health committees and National Health Commission of the People's Republic of China from Jan. 10 to Mar. 30, 2020 were collected, as well as the daily data and papers of COVID-19 published by the epidemic countries and the World Health Organization until Apr. 16, 2020. The epidemiological characteristics (including the number of confirmed cases, fatality rate, critical rate and cure rate, etc.) were used to analyze the epidemic development and the effects of prevention and control measures in different regions of China, and they were compared with the epidemic prevention and control effects of the United States and Italy. Results The epidemic showed the characteristics of outbreak, and the cases increased rapidly. COVID-19 infection was found in 31 provincial-level regions in Chinese mainland, Hong Kong and Macao special administrative regions and Taiwan Province. The mortality rates were 4.01% (3 314/82 545), 5.10% (2 548/50 006) and 3.59% (639/17 795) in China, Wuhan and Hubei (excluding Wuhan), respectively. The national average cure rate was 92.34% (76 225/82 545). The new cases in Wuhan were the most in the country after restricting traffic and personnel flow, and the average newly diagnosed cases outside Hubei dropped from 521.00 to 474.40 cases. The average daily deaths decreased from 72.33 to 38.35 in Wuhan and 97.87 to 47.61 in the whole country after treating patients in isolation. Compared with the United States and Italy, China took the most effective measures and had the lowest rate of case increase. Conclusion COVID-19 has been found in all provincial-level regions of China. The prevention and control measures in China have effectively contained the progress of the epidemic. Compared with the United States and Italy, prevention and control measures in China are more prompt and effective.

Abstract:Objective To investigate the role of Jiawei Sijunzi decoction (JSD) in delaying aging of mouse spleen tissue and its possible mechanism. Methods Forty 8-week-old male Kunming mice were evenly randomized into low-dose group, high-dose group, model group and control group (n=10). The aging models were established by intraperitoneal injection of 0.2 g/kg D-galactose in the low-dose, high-dose and model groups. The low-dose and high-dose groups were given JSD 1.6 and 6.4 g/kg by gavage, respectively, and the model group and control group were given the same volume of normal saline for 42 consecutive days. The pathological changes of the spleen tissue were observed, the spleen index was calculated, and the serum immunoglobulin G (IgG) level was detected. The mRNA expression levels of phosphatidylinositol 3-kinase (PI3K), p70 ribosomal protein S6 kinase (P70S6K) and eukaryotic translation initiation factor 4E binding protein 1 (4E-BP1) of mammalian target of rapamycin (mTOR) signaling pathway were detected by quantitative real-time polymerase reaction (qRT-PCR). Results With obvious pathological changes, the spleen index and the serum IgG level of the model group were significantly lower than those of the control group (all P<0.05), while the mRNA expression levels of PI3K and P70S6K in spleen tissue were significantly higher than those in the control group (all P<0.05). The pathological changes of the spleen tissue in the high-dose and low-dose groups were lighter than those in the model group, the spleen index and the serum IgG level in the high-dose group were significantly higher than those in the model group (all P<0.05), while the mRNA expression levels of PI3K and P70S6K in the spleen tissue of the low-dose and high-dose groups were significantly lower than those of the model group (all P<0.05). Conclusion JSD can improve the aging degeneration of spleen tissue in mice, and the mechanism may be related to the inhibition of mTOR signal pathway.

Abstract:Objective To investigate the effects of losartan (an angiotensin receptor blocker[ARB]) combined with spironolactone (an aldosterone receptor antagonist) on basilar artery and cognitive functions of elderly spontaneous hypertension rats (SHR). Methods Eighteen elderly male SHR rats were evenly randomized into SHR group (SHR control group), L group (losartan 20 mg/[kg·d]), and L+S group (losartan 20 mg/[kg·d]and spironolactone 10 mg/[kg·d]at the same time); six age-matched male Wistar Kyoto (WKY) rats with normal blood pressure served as controls (WKY group). Drug intervention lasted for 4 weeks by gavage after 4 weeks of adaptation. The blood pressure of rats in each group was measured by noninvasive tail-cuff method. Spatial memory ability was tested by Y-maze, and systolic and diastolic functions of rat basilar artery were tested with isolated vascular rings. Results The systolic blood pressure (SBP) of rats in SHR group was significantly higher than that in WKY group, while the SBP of rats in L group and L+S group was significantly lower than that in SHR group, with more significant decline in L+S group (all P<0.05). In the Y-maze test, no significant difference was found in spontaneous alternation rates between SHR group and WKY group (P>0.05). The spontaneous alternation rate of L group was significantly lower than that of SHR group (P<0.05). The spontaneous alternation rate of L+S group was significantly lower than those of L group and WKY group (both P<0.05). The systolic response of rat basilar artery in SHR group was stronger than that in WKYgroup in a low-concentration KCl solution, while it was weakened in a high-concentration KCl solution; losartan alone could enhance the systolic response of basilar artery, but the combined use of losartan and spironolactone could significantly reduce the systolic response. Conclusion ARBs combined with aldosterone receptor antagonists can effectively control blood pressure, but adverse effects may appear on the cognitive function of elderly SHR if the blood pressure becomes too low.

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