[Risk assessment of Cronobacter sakazakii in infant formula powder]

Objective: To assess the risk of foodborne diseases caused by Cronobacter sakazakii in infant formula powder from retail to feeding and provide formulate suggestions for safe feeding of infants at home. Methods: This study used the special monitoring and risk monitoring data of infant formula powder in Heilongjiang Province and combined data at home and abroad. The @RISK software was used to evaluate the disease risk caused by Cronobacter sakazakii in the process of infant formula powder from retail to feeding. Results: According to the results of this quantitative risk assessment, the risk of foodborne diseases caused by Cronobacter sakazakii at the current consumption pattern in Heilongjiang Province was 5.158×10^-5 persons/million (40.0 ℃ and 50.0 ℃), 1.072×10^-7 persons/million (60.0 ℃), 5.544×10^-14 persons/million (70.0 ℃). When the feeding time of infant formula powder was adjusted to 0-2 h and 2-3 h respectively, the above prediction results did not change. When it was adjusted to 3-4 h, the risk increased. If it was adjusted to 4-24 h, the number of Cronobacter sakazakii increased by 14-24 orders of magnitude at room temperature. If the initial pollution concentration (after flushing) was adjusted to 1 MPN/ml, the average disease risk per meal was 805.7 persons/million (40.0 ℃ and 50.0 ℃), 1.7 persons/million (60.0 ℃) and 9.1 × 10^-7 persons/million (70.0 ℃). The results of sensitivity analysis showed that the water temperature (70.0 ℃), initial pollution concentration, room storage time and temperature were important factors of risk. Conclusion: Controlling the contamination level of Cronobacter sakazakii in infant formula powder, controlling the feeding time within 3 h, storing in refrigerator and mixing with water with temperature not lower than 70.0 ℃ are effective measures to prevent infants from eating infant formula powder infected by Cronobacter sakazakii.

Beam particle identification and tagging of incompletely stripped heavy beams with HEIST

A challenge preventing successful inverse kinematics measurements with heavy nuclei that are not fully stripped is identifying and tagging the beam particles. For this purpose, the HEavy ISotope Tagger (HEIST) has been developed. HEIST utilizes two micro-channel plate timing detectors to measure the time-of-flight, a multi-sampling ion chamber to measure energy loss, and a high-purity germanium detector to identify isomer decays and calibrate the isotope identification system. HEIST has successfully identified ¹⁹⁸Pb and other nearby nuclei at energies of about 75 MeV/A. In the experiment discussed, a typical cut containing 89% of all ¹⁹⁸Pb⁸⁰⁺ in the beam had a purity of 86%. We examine the issues of charge state contamination. The observed charge state populations of these ions are presented and, using an adjusted beam energy, are well described by the charge state model GLOBAL.

First Observation of the Four-Proton Unbound Nucleus ^{18}Mg

^{18}Mg was observed, for the first time, by the invariant-mass reconstruction of ^{14}O+4p events. The ground-state decay energy and width are E_{T}=4.865(34)  MeV and Γ=115(100)  keV, respectively. The observed momentum correlations between the five particles are consistent with two sequential steps of prompt 2p decay passing through the ground state of ^{16}Ne. The invariant-mass spectrum also provides evidence for an excited state at an excitation energy of 1.84(14) MeV, which is likely the first excited 2^{+} state. As this energy exceeds that for the 2^{+} state in ^{20}Mg, this observation provides an argument for the demise of the N=8 shell closure in nuclei far from stability. However, in open systems this classical argument for shell strength is compromised by Thomas-Ehrman shifts.

[Use of alternative pancreatic fistula risk score system for patients with clinical relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy]

Objective: To examine the application value of alternative pancreatic fistula risk score system(a-FRS) for patients with clinically relevant postoperative pancreatic fistula(CR-POPF) after laparoscopic pancreaticoduodenectomy(LPD). Methods: Clinical data of 400 patients who underwent LPD at Department of Hepatobiliary and Pancreatic Surgery,Jilin University First Hospital,from April 2015 to August 2019 were retrospectively analyzed.There were 217 males and 183 females, with age of (M(Q_R)) 58 (53) years (range:26 to 93 years) and body mass index of (23.0±2.7) kg/m² (range:19.4 to 27.1 kg/m²).Preoperative CA19-9 was (171.6±212.7) U/ml (range:32.1 to 762.6 U/ml), and preoperative CA125 was (18.6±22.9) U/ml (range:9.0 to 112.3 U/ml).Univariate analysis and multivariate Logistic regression analysis were implemented to find independent risk factors in CR-POPF.According to 3 indicators of a-FRS system(pancreatic texture,main pancreatic duct diameter,and body mass index),receiver operator characteristic curve was used to prospectively analyze the clinical value of CR-POPF. Results: CR-POPF occurred in 60 patients(15.0%) among the 400 LPD patients,including 54 patients(13.5%) with grade B pancreatic fistula and 6 patients(1.5%) with grade C pancreatic fistula.Univariate and multivariate Logistic regression analysis results showed that soft pancreas,diameter of main pancreatic duct ≤3 mm,and body mass index>23 kg/m² were the independent risk factors for CR-POPF after LPD.The incidence of CR-POPF was 1.9% in the group with low pancreatic fistula risk(0 to 5%),5.9% with moderate pancreatic fistula risk(>5% to 20%),and 80.7% with high pancreatic fistula risk(>20%).a-FRS prospectively predicted the sensitivity and specificity of CR-POPF after LPD was 76.7% and 96.8%,positive predictive value was 80.7%,negative predictive value was 95.9%,positive likelihood ratio was 23.66,negative likelihood ratio was 0.24,and area under the curve was 0.735(95%CI:0.668-0.799). Conclusion: a-FRS system has great clinical application value in predicting CR-POPF after LPD,which can provide basis for early risk prediction of CR-POPF and timely related clinical intervention.

[Liraglutide alleviates lipotoxic liver cell damage and promotes autophagy to improve non-alcoholic fatty liver]

Objective: To study the effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on free fatty acid (FFA)-induced hepatocyte steatosis, and to explore its autophagic role in this process. Methods: Human hepatocytes were cultured in vitro to induce NAFLD cell model. Liraglutide (LRG) concentration gradient was added to observe the effect on cell survival rate and fatty degeneration of liver cells. The relationship between liraglutide and autophagy was investigated with chloroquine inhibition and rapamycin (RAPA) activation in hepatocyte steatosis. Experimental group: control group: a certain concentration of BSA was added to cells cultured in DMEM complete medium; FFA model group: fatty degeneration of hepatocytes was induced by 1mmol/L FFA (OA : PA=2 : 1); LRG group: FFA (1 mmol/L) and LRG (100 nmol/L) were added to the cells at the same time; autophagy inhibition group: FFA (1 mmol/L), LRG (100 nmol/L), and chloroquine (20 μmol/L) were added to the cells at the same time; autophagy activated group: FFA (1 mmol/L) and RAPA (1 μmol/L) were added to the cells at the same time. Oil red O staining and fully automated biochemistry analyzer were used to observe the intracellular lipidosis condition. Western blotting was used to detect the levels of autophagy-related proteins (Beclin1, P62, and LC3B). One-way analysis of variance was used to compare the means between multiple groups. Results: Within a certain concentration range, with the increase of LRG concentration, the hepatocytes survival rate was increased and the degree of intracellular lipidosis had continued to decrease. The best effect was achieved when LRG concentration reached 100nmol/L, and the difference was statistically significant when compared with the FFA group (P < 0.01). During the exploration of the relationship between the degree of hepatic steatosis and autophagy, LRG group intracellular triglyceride content was significantly lower than FFA group (P < 0.01), and the levels of Beclin1, LC3B-II/LC3B-I were higher than FFA group. Additionally, FFA group had reduced P62 level, and enhanced autophagy. Compared with the LRG group, autophagy inhibition group intracellular triglyceride content was increased (P < 0.01), while the levels of Beclin1, LC3B-II/LC3B-I was decreased, and P62 level was increased. Autophagy activated group RAPA had significantly reduced FFA-induced intrahepatic triglyceride deposition, and the changes in autophagy-related protein levels were consistent with the effect of LRG. Conclusion: GLP-1RAs can alleviates FFA-induced lipotoxic liver cell damage, and promote autophagy to improve fatty degeneration of hepatocytes in NAFLD.

Application of potassium competitive acid blockers in acid-related diseases

Acid-related diseases (ARDs) are common chronic diseases of the digestive system. Proton pump inhibitors (PPIs) have become the first-line drugs for the treatment of acid-related diseases. However, PPIs display some limitations in clinical application, such as short half-life, slow action, insufficient acid inhibition, pharmacological effects affected by CYP2C19 gene polymorphism, and nocturnal acid breakthrough, which lead to insufficient symptom remission of ARDs, as well as refractoriness, relapse, and even direct decline in health-related quality of life and increased economic burden. Potassium competitive acid blockers (P-CABs) are a class of novel anti-secretory drugs, which can overcome the limitations of traditional PPIs and show satisfactory acid inhibition effect and safety in clinical application. They may become a new strategy to solve the unsatisfied medical needs in the treatment of ARDs, but their potential adverse reactions remain to be monitored. In this article, we review the challenges in the treatment of acid-related diseases, and the advantages and prospects of P-CABs in the prevention and treatment of ARDs.

Application prospects of glucagon-like peptide-1 receptor agonists in treatment of metabolic diseases

Metabolic syndrome [overweight, obesity, type 2 diabetes mellitus (T2DM), and lipid metabolism disorder] is directly related to cardiovascular diseases, non-alcoholic fatty liver disease (NAFLD), tumors, and other diseases, and its prevalence has been increasing sharply, bringing an increasingly heavy burden on society. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a novel class of glucose-dependent hypoglycemic drugs modified from glucagon-like peptide-1. Since their mechanism of action is different from that of traditional insulin and oral secretagogues, they overcome the adverse reactions associated with traditional oral medications and insulin, can improve the success rate of T2DM control, and has been widely used in the treatment of T2DM. Recent studies have found that, in addition to hypoglycemic effect, GLP-1RAs can improve metabolic diseases, such as diabetes-related complications, NAFLD, and cardiovascular diseases, and therefore have broad application prospects. This paper reviews the potential role of GLP-1RAs in these diseases.

Bioinformatics analysis reveals novel core genes associated with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis

Nonalcoholic fatty liver disease (NAFLD) is the most frequent liver disease and associated with a wide spectrum of hepatic disorders ranging from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH), cirrhosis, and hepatocellular carcinoma (HCC). NASH is projected to become the most common indication for liver transplantation, and the annual incidence rate of NASH-related HCC is 5.29 cases per 1000 person-years. Owing to the epidemics of NAFLD and the unclear mechanism of NAFLD progression, it is important to elucidate the underlying NAFLD mechanisms in detail. NASH is mainly caused by the development of NAFL Therefore, it is also of great significance to understand the mechanism of progression from NAFL to NASH. Gene expression chip data for NAFLD and NASH were downloaded from the Gene Expression Omnibus database to identify differentially expressed genes (DEGs) between NAFLD and normal controls (called DEGs for NAFLD), as well as between NASH and normal tissue (called DEGs for NASH-Normal), and between NASH and NAFL tissue (called DEGs for NASH-NAFL). For DEGs for the NAFLD group, key genes were identified by studying the form of intersection. Potential functions of DEGs for NASH were then analyzed by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses. A protein-protein interaction network (PPI) was constructed using the STRING database. A total of 249 DEGs and one key gene for NAFLD were identified. For NASH-Normal, 514 DEGs and 11 hub genes were identified, three of which were closely related to the survival analysis of HCC, and potentially closely related to progression from NASH to HCC. One key gene for NASH-NAFL (AKR1B10) was identified. These genes appear to mediate the molecular mechanism underlying NAFLD and may be promising biomarkers for the presence of NASH.

From "two hit theory" to "multiple hit theory": Implications of evolution of pathogenesis concepts for treatment of non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is becoming a burgeoning and burdensome public health problem worldwide, along with diabetes and metabolic syndrome. In the NAFLD spectrum, non-alcoholic steatohepatitis can progress to hepatic fibrosis, especially progressive fibrosis, which can lead to cirrhosis or even hepatocellular carcinoma. However, the pathogenesis of NAFLD is extremely complex and has not yet been fully elucidated, thus there is a lack of effective treatment. In recent years, the classic "two-hit" hypothesis has been gradually surpassed and supplemented by a great deal of findings, and the "multiple hit" hypothesis has been proposed and is being accepted. The study on the interaction among cellular and molecular mechanisms, environmental and genetic factors has revealed a number of critical targets in the pathogenesis of NAFLD, providing broad directions for the development of diagnostic markers and targeted therapeutic drugs. Here we elaborate the latest advances in understanding the pathogenesis of NAFLD from multiple perspectives, in order to analyze and evaluate the prospect of developing diagnostic biomarkers and therapeutic targets based on those pathogeneses.

Proton Shell Evolution below ^{132}Sn: First Measurement of Low-Lying β-Emitting Isomers in ^{123,125}Ag

The β-delayed γ-ray spectroscopy of neutron-rich ^{123,125}Ag isotopes is investigated at the Radioactive Isotope Beam Factory of RIKEN, and the long-predicted 1/2^{-} β-emitting isomers in ^{123,125}Ag are identified for the first time. With the new experimental results, the systematic trend of energy spacing between the lowest 9/2^{+} and 1/2^{-} levels is extended in Ag isotopes up to N=78, providing a clear signal for the reduction of the Z=40 subshell gap in Ag towards N=82. Shell-model calculations with the state-of-the-art V_{MU} plus M3Y spin-orbit interaction give a satisfactory description of the low-lying states in ^{123,125}Ag. The tensor force is found to play a crucial role in the evolution of the size of the Z=40 subshell gap. The observed inversion of the single-particle levels around ^{123}Ag can be well interpreted in terms of the monopole shift of the π1g_{9/2} orbitals mainly caused by the increasing occupation of ν1h_{11/2} orbitals.

Estimation of Lower Developmental Threshold and Degree Days for Pupal Development of Different Geographical Populations of Chinese Citrus Fly (Diptera: Tephritidae) in China

The lower developmental threshold (LDT) and the number of developmental degree days (DDs) are fundamental parameters used to build phenology models that can be used to predict the timing of biological events during insect development. The Chinese citrus fly, Bactrocera minax (Enderlein) (Diptera: Tephritidae) is one of the most destructive citrus pest in China and Bhutan. This species overwinters as diapausing pupae in the soil before emerging as adults in the spring. In this study, B. minax collected from three representative geographical populations in China (Guizhou, Hubei, and Shaanxi) was used to conduct LDT experiments under laboratory conditions. Emergence data collected from pupae exposed to 10 constant temperatures was used to estimate the LDT and DDs required to complete pupal development for the three populations. The results show that LDT and DDs values for the Hubei and Shaanxi population are 11.9°C, 447.3 DDs and 11.5°C, 511.3 DDs, respectively. However, the geographic variation in pupal developmental rates was not statistically significant between the two populations. In addition, the Guizhou population was identified as a mixture of B. minax and B. tsuneonis (Miyake). The LDT and DDs values for the Hubei and Shaanxi populations obtained in this study can be used to predict adult emergence of naturally occurring field populations of B. minax within the majority of the citrus-growing production areas of China. These data can also be used in models to predict the risk of establishment of this species in the United States or other citrus-growing regions.

Individualized medicine of gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common disease worldwide, and its prevalence is increasing in both developed and developing countries. GERD is divided into three subtypes, namely, erosive esophagitis, nonerosive reflux disease (NERD), and Barrett's esophagus. The etiology, pathogenesis, clinical manifestations, and response to treatment of GERD invariably show high heterogeneity or significant individual difference, especially NERD and refractory GERD. On the other hand, advanced technology has currently provided a wide range of methods for the diagnosis and treatment of GERD patients; however, the long-term efficacy and quality of life of some patients are unsatisfactory. Therefore, each GERD patient needs a specialized management strategy aiming at his/her own condition, which is known as individualized medicine or personalized medicine. The goal of GERD treatment is to relieve the symptoms, while symptomatic remission is directly related to the quality of life. In other words, health-related quality of life and patient satisfaction may be reasonable criteria for GERD. In this paper, we will discuss the individualized medicine of GERD.

Roles of Autophagy and Protein Kinase C-epsilon in Lipid Metabolism of Nonalcoholic Fatty Liver Cell Models

OBJECTIVE

To investigate interaction between autophagy and PKC-ε in lipid metabolism of NAFLD cell models.

METHODS

HL-7702 cells and SK-HEP-1 cells were cultured in vitro as NAFLD cell models and treated with RAPA to induce autophagy. 3-MA was used to inhibit cell autophagy. And HL-7702 and SK-HEP-1 cell were ordinary cultured as control groups. Cell viability was determined by MTT colorimetric assay. The levels of TG, TC and PKC-ε were detected by ELISA. PKC-ε was detected by IF. LC3-II/LC3-I, P62, IRS-1, IRS-2, PI3Kp85, mTOR were detected by Western-blot. SPSS 20 software was used for statistical analysis.

RESULTS

The values of PKC-ε were the highest in the steatosis groups (HL-7702 cells were 91.10%, SK-HEP-1 cells were 98.20%). Compared with the steatosis groups, the LC3-II/LC3-I ratio in the induced autophagy groups increased obviously (p <0.05). P62/β-actin grayscale ratio of the induced autophagy groups decreased significantly compared with the steatosis group (p <0.05). MTOR/β-actin grayscale ratio in the induced autophagy groups were significantly lower than those in the steatosis groups (p <0.05). PI3Kp85, IRS-1 and IRS-2/β-actin grayscale ratio of the induced autophagy groups increased significantly compared with the steatosis group (p <0.05).

CONCLUSION

Up-regulation of autophagy can promote the elimination of liver fat; while down-regulation can promote lipid accumulation. The expression of PKC-ε is positively related to the degree of hepatic steatosis. PI3K was involved in both autophagy and IR induced by PKC-ε. PKC-ε might participate in hepatocyte autophagy by regulating PI3K.

Research status of fatty pancreas

Fatty pancreas is a newly proposed condition which is characterized by fat deposition and steatosis in the pancreas followed by outcome of pancreatic and metabolic complications. It has been found to be correlated with many metabolic disorders and a variety of diseases. Fatty pancreas has been associated with obesity, non-alcoholic fatty liver disease, metabolic syndrome, type 2 diabetes mellitus, acute and chronic pancreatitis, and even pancreatic carcinoma. Therefore, fatty pancreas might not only be an early marker of glucose or lipid metabolism disorders or metabolic syndrome, but also be a predictor of poor outcome of pancreatic related diseases. At present, imaging examination is the main diagnostic method. However, there is currently still a lack of a unified terminology, diagnostic criteria, treatment consensus, and guidelines due to very limited knowledge on this condition. Here we discuss the pathophysiology, pathogenesis, clinical implications, diagnosis, and treatment of fatty pancreas, with an aim to improve the early intervention, treatment, and prognosis prediction of fatty pancreas related metabolic disorders.

[Advances in epidemiology and serum markers for the noninvasive diagnosis of nonalcoholic fatty liver disease]

The global prevalence rate of nonalcoholic fatty liver disease (NAFLD) has increased year by year, and it has become the number one cause for chronic liver disease in China. In addition, the trend of NAFLD has become more pronounced and evident in female gender and younger age group. The long-term persistence of fatty liver disease may cause serious consequences. There are no accepted diagnostic criteria for diagnosing noninvasive diagnosis of NAFLD. Alpha-ketoglutarate is a newly discovered serological marker of high diagnostic value and considered the most valuable potential biomarker along with cytokeratine-18 (CK-18).

Evaluation of ascitic soluble human leukocyte antigen-G for distinguishing malignant ascites from benign ascites

The overexpression of soluble human leukocyte antigen-G is associated with malignant tumours. The purpose of our study was to detect soluble human leukocyte antigen-G concentrations in ascites and to evaluate the value of ascitic soluble human leukocyte antigen-G for the diagnosis of malignant ascites. Enzyme-linked immunosorbent assay was used to detect soluble human leukocyte antigen-G levels in 64 patients with malignant ascites and 30 patients with benign ascites. Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of ascitic soluble human leukocyte antigen-G for the detection of malignant ascites. Ascitic soluble human leukocyte antigen-G levels were significantly higher in the malignant ascites group than in the benign ascites group (20.718 ± 3.215 versus 12.467 ± 3.678 µg/L, t = 7.425, p < 0.001). The area under the receiver operating characteristic curve for ascitic soluble human leukocyte antigen-G was 0.957 (95% confidence interval, 0.872-0.992). At a cut-off value of 19.60 µg/L, the sensitivity and specificity of ascitic soluble human leukocyte antigen-G were 87.5% (95% confidence interval, 71.0%-96.5%) and 100% (95% confidence interval, 88.4%-100%), respectively. With respect to area under the receiver operating characteristic curve, sensitivity and specificity, ascitic carcinoembryonic antigen (0.810, 68.75% and 83.33%, respectively) and carbohydrate antigen 19-9 (0.710, 65.63% and 70%, respectively) significantly differed (all p < 0.05). In malignant ascites that were cytology-negative and biopsy-positive, the rate of positivity for ascitic soluble human leukocyte antigen-G was 75%, which was higher than the corresponding rates for ascitic carcinoembryonic antigen (31.25%) and carbohydrate antigen 19-9 (6.25%; both p < 0.05). In conclusion, The detection of ascitic soluble human leukocyte antigen-G exhibited good performance for diagnosing malignant ascites, and particularly those that were cytology-negative and biopsy-positive.

Hydrogen sulfide in posthemorrhagic shock mesenteric lymph drainage alleviates kidney injury in rats

Posthemorrhagic shock mesenteric lymph (PHSML) is a key factor in multiple organ injury following hemorrhagic shock. We investigated the role of hydrogen sulfide (H₂S) in PHSML drainage in alleviating acute kidney injury (AKI) by administering D,L-propargylglycine (PPG) and sodium hydrosulfide hydrate (NaHS) to 12 specific pathogen-free male Wistar rats with PHSML drainage. A hemorrhagic shock model was established in 4 experimental groups: shock, shock+drainage, shock+drainage+PPG (45 mg/kg, 0.5 h prehemorrhage), and shock+drainage+NaHS (28 µmol/kg, 0.5 h prehemorrhage). Fluid resuscitation was performed after 1 h of hypotension, and PHMSL was drained in the last three groups for 3 h after resuscitation. Renal function and histomorphology were assessed along with levels of H₂S, cystathionine-γ-lyase (CSE), Toll-like receptor 4 (TLR4), interleukin (IL)-10, IL-12, and tumor necrosis factor (TNF)-α in renal tissue. Hemorrhagic shock induced AKI with increased urea and creatinine levels in plasma and higher H₂S, CSE, TLR4, IL-10, IL-12, and TNF-α levels in renal tissue. PHSML drainage significantly reduced urea, creatinine, H₂S, CSE, and TNF-α but not TLR4, IL-10, or IL-12. PPG decreased creatinine, H₂S, IL-10, and TNF-α levels, but this effect was reversed by NaHS administration. In conclusion, PHSML drainage alleviated AKI following hemorrhagic shock by preventing increases in H₂S and H₂S-mediated inflammation.

Drug utilization review and drug utilization evaluation for evaluation of usage of hepatoprotective drugs in patients with hepatitis: Analysis of 129 cases

AIM: To assess the value of drug utilization review (DUR) and drug utilization evaluation (DUE) in the evaluation of the rationality of usage of hepatoprotective drugs at our hospital.

METHODS: DUR and DUE methods were used to analyze drug use index (DUI), medication, treatment monitoring and treatment results in hospitalized patients with hepatitis at our hospital.

RESULTS: Of the hepatoprotective drugs used in 129 hepatitis patients, two had a DUI > 1, two had a DUI < 1 and five had a DUI = 1, which accounted for 22.2%, 22.2% and 55.6% of all surveyed hepatoprotective drug varieties, respectively. The frequencies of usage of the top three drugs were Silibinin Capsules (52.78%), Reduced Glutathione Injection (21.23%) and Polyene Phosphatidylcholine Injection (21.04%), respectively. The frequencies of single, double, triple and quadruple therapies were 15.5%, 48.1%, 34.9% and 1.6%, respectively. Liver function returned to normal or showed improvement in 55%, 96.8%, 86.7% and 50% of patient receiving single, double, triple and quadruple therapies, respectively, which showed a significant difference (P < 0.01). Double therapy had the best therapeutic effect, followed by triple, single and quadruple therapies.

CONCLUSION: The usage of hepatoprotective drugs in hepatitis patients at our hospital was basically reasonable, and double therapy had the best therapeutic effect.

Mesenteric lymph reperfusion exacerbates spleen injury caused by superior mesenteric artery occlusion shock

The intestinal lymph pathway plays an important role in the pathogenesis of organ injury following superior mesenteric artery occlusion (SMAO) shock. We hypothesized that mesenteric lymph reperfusion (MLR) is a major cause of spleen injury after SMAO shock. To test this hypothesis, SMAO shock was induced in Wistar rats by clamping the superior mesenteric artery (SMA) for 1 h, followed by reperfusion for 2 h. Similarly, MLR was performed by clamping the mesenteric lymph duct (MLD) for 1 h, followed by reperfusion for 2 h. In the MLR+SMAO group rats, both the SMA and MLD were clamped and then released for reperfusion for 2 h. SMAO shock alone elicited: 1) splenic structure injury, 2) increased levels of malondialdehyde, nitric oxide (NO), intercellular adhesion molecule-1, endotoxin, lipopolysaccharide receptor (CD14), lipopolysaccharide-binding protein, and tumor necrosis factor-α, 3) enhanced activities of NO synthase and myeloperoxidase, and 4) decreased activities of superoxide dismutase and ATPase. MLR following SMAO shock further aggravated these deleterious effects. We conclude that MLR exacerbates spleen injury caused by SMAO shock, which itself is associated with oxidative stress, excessive release of NO, recruitment of polymorphonuclear neutrophils, endotoxin translocation, and enhanced inflammatory responses.

Exogenous normal lymph reduces liver injury induced by lipopolysaccharides in rats

The liver is one of the target organs damaged by septic shock, wherein the spread of endotoxins begins. This study aimed to investigate the effects of exogenous normal lymph (ENL) on lipopolysaccharide (LPS)-induced liver injury in rats. Male Wistar rats were randomly divided into sham, LPS, and LPS+ENL groups. LPS (15 mg/kg) was administered intravenously via the left jugular vein to the LPS and LPS+ENL groups. At 15 min after the LPS injection, saline or ENL without cell components (5 mL/kg) was administered to the LPS and LPS+ENL groups, respectively, at a rate of 0.5 mL/min. Hepatocellular injury indices and hepatic histomorphology, as well as levels of P-selectin, intercellular adhesion molecule 1 (ICAM-1), myeloperoxidase (MPO), and Na⁺-K⁺-ATPase, were assessed in hepatic tissues. Liver tissue damage occurred after LPS injection. All levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in plasma as well as the wet/dry weight ratio of hepatic tissue in plasma increased. Similarly, P-selectin, ICAM-1, and MPO levels in hepatic tissues were elevated, whereas Na⁺-K⁺-ATPase activity in hepatocytes decreased. ENL treatment lessened hepatic tissue damage and decreased levels of AST, ALT, ICAM-1, and MPO. Meanwhile, the treatment increased the activity of Na⁺-K⁺-ATPase. These results indicated that ENL could alleviate LPS-induced liver injury, thereby suggesting an alternative therapeutic strategy for the treatment of liver injury accompanied by severe infection or sepsis.

Incidence of gastroesophageal reflux disease in Uygur and Han Chinese adults in Urumqi

AIM: To investigate the incidence of gastroesophageal reflux disease (GERD) and its related risk factors in Uygur and Han Chinese adult in Urumqi, China.

METHODS: A population-based cross-sectional survey was undertaken in a total of 972 Uygur (684 male and 288 female) aged from 24 to 61 and 1023 Han Chinese (752 male and 271 female) aged from 23 to 63 years. All participants were recruited from the residents who visited hospital for health examination from November 2011 to May 2012. Each participant signed an informed consent and completed a GERD questionnaire (Gerd Q) and a lifestyle-food frequency questionnaire survey. Participants whose Gerd Q score was ≥ 8 and met one of the following requirements would be enrolled into this research: (1) being diagnosed with erosive esophagitis (EE) or Barrett’s esophagus (BE) by endoscopy; (2) negative manifestation under endoscopy (non-erosive reflux disease, NERD) with abnormal acid reflux revealed by 24-h esophageal pH monitoring; and (3) suffering from typical heartburn and regurgitation with positive result of proton pump inhibitor test.

RESULTS: According to Gerd Q scoring criteria, 340 cases of Uygur and 286 cases of Han Chinese were defined as GERD. GERD incidence in Uygur was significantly higher than in Han Chinese (35% vs 28%, χ² = 11.09, P < 0.005), Gerd Q score in Uygur was higher than in Han Chinese (7.85 ± 3.1 vs 7.15 ± 2.9, P < 0.005), and Gerd Q total score in Uygur male was higher than in female (8.15 ± 2.8 vs 6.85 ± 2.5, P < 0.005). According to normalized methods, 304 (31%) cases of Uygur were diagnosed with GERD, including 89 cases of EE, 185 cases of NERD and 30 cases of BE; 256 (25%) cases of Han Chinese were diagnosed with GERD, including 90 cases of EE, 140 cases of NERD and 26 cases of BE. GERD incidence in Uygur was significantly higher than in Han Chinese (31% vs 25%, χ² = 9.34, P < 0.005) while the incidences were higher in males of both groups than in females (26% vs 5% in Uygur, χ² = 35.95, P < 0.005, and 19.8% vs 5.2% in Han, χ² = 5.48, P < 0.025). GERD incidence in Uygur male was higher than in Han Chinese male (26% vs 19.8%, χ² = 16.51, P < 0.005), and incidence of NERD in Uygur was higher than in Han Chinese (χ² = 10.06, P < 0.005). Occupation (r = 0.623), gender (r = 0.839), smoking (r = 0.322), strong tea (r = 0.658), alcohol drinking (r = 0.696), meat-based diet (mainly meat) (r = 0.676) and body mass index (BMI) (r = 0.567) were linearly correlated with GERD in Uygur (r = 0.833, P = 0.000); while gender (r = 0.957), age (r = 0.016), occupation (r = 0.482), strong tea (r = 1.124), alcohol drinking (r = 0.558), meat diet (r = 0.591) and BMI (r = 0.246) were linearly correlated with GERD in Han Chinese (r = 0.786, P = 0.01). There was no significant difference between Gerd Q scoring and three normalized methods for the diagnosis of GERD.

CONCLUSION: GERD is highly prevalent in adult in Urumqi, especially in Uygur. Male, civil servant, smoking, strong tea, alcohol drinking, meat diet and BMI are risk factors correlated to GERD.

Identification and characterization of flavonoids from semen zizyphi spinosae by high-performance liquid chromatography/linear ion trap FTICR hybrid mass spectrometry

Semen zizyphi spinosae (SZS) has been used to treat insomnia and anxiety for thousands of years. In this paper, a novel high-performance liquid chromatography coupled with the photodiode array detector/linear ion trap-MS(n) (HPLC-PDA/LTQ-MS(n)) method was established to separate and identify flavonoids from the extract of SZS. Separation was performed on an HYPERSIL C(18) column by gradient elution using CH(3)CN/H(2)O-CH(3)COOH as the mobile phase at a flow rate of 0.8 ml/min. UV spectral data, accurate molecular weights, and multi-stage MS/MS fragmentation information were obtained. Electrospray ionization/MS/MS fragmentation patterns were proposed. Nineteen flavonoid glycosides were identified or tentatively characterized based on their retention time, UV spectral data, accurate molecular weights, and mass fragmentation behavior. The method was useful for separation and identification of the flavonoid components from SZS and could be applied to other complex samples, especially for minor constituents.

Efficacy of immunotherapy using autologous dendritic cells pulsed with hepatitis B surface antigen in patients with chronic hepatitis B

AIM: To investigate the efficacy of immunotherapy using hepatitis B surface antigen (HbsAg)-pulsed autologous dendritic cells (DCs) in patients with chronic hepatitis B (CHB).

METHODS: After autologous DCs were loaded with HbsAg and cultured, they were intravenously infused back to patients. The overall course of treatment was divided into four phases: three months of intensive therapy, three months of consolidation therapy, six months of observation of short-term curative effect, and one year of observation of long-term curative effect. A high-throughput detection of HBV mutations was performed in each patient before therapy. Liver and renal function, HBV DNA level and HBV markers were measured in all patients before and after each treatment.

RESULTS: HBV core gene mutations occurred in 15.1% of patients (58/384). Of 134 patients with HBeAg-positive CHB, 58 showed virological response to the therapy, 21 showed serological response, and 75 showed biochemical response. Of 102 patients with HBeAg-negative CHB, 40 showed virological response, and 53 showed biochemical response. Complete response was observed in 112 (29.2%) and 124 (32.4%) patients in one and two years, respectively. After treatment, serum HBsAg, HBeAg and HBV DNA levels significantly decreased (2484.39 ± 185.2 ng/L vs 1616.28 ± 169.81 ng/L; 32.1 ± 5.78 ng/L vs69.9 ± 7.61 ng/L; 0.08 ± 1.78 × 10⁸ copies/L vs 1.79 ± 1.21 × 10⁸ copies/L, all P < 0.05 or 0.01). No serious adverse events were noted during and after treatment.

CONCLUSION: HbsAg-pulsed DCs are effective in the treatment of CHB patients and HBV carriers.

Relationship between the acid-suppression efficacy of proton pump inhibitors and the CYP2C19 genetic polymorphism in patients with peptic ulcer

AIM: To investigate the acid-suppression efficacy of proton pump inhibitors (PPIs) in relation to the CYP2C19 genetic polymorphism in patients with peptic ulcer.

METHODS: In an open, randomized controlled trial, 59 patients with active peptic ulcer were randomly assigned to receive one of three PPIs in a single dose (20 mg of each drug): omeprazole (OME) (n = 19), rabeprazole (RAB) (n = 20) and esomeprazole (ESO) (n = 20). The level of 24 h intragastric pH was dynamically monitored. The 24 h and night acid-suppression effects of the three drugs were observed. The CYP2C19 genotype was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in all patients.

RESULTS: The extensive metabolizers/poor metabolizers (EMs/PMs) ratio in the OME, RAB and ESO groups was 16/3, 17/3 and 17/3, respectively. The 24 h and night acid-suppression effects [(total time and time percent (pH > 4)] in PMs were significantly higher than those in EMs in the OME group [24 h acid suppression: (total time: 10.65 ± 2.3 h vs 7.22 ± 2.1 h, P < 0.05; time percent: 48.9 ± 15.5 vs 32.5 ± 12.6, P < 0.05); and night acid suppression: (total time: 3.67 ± 1.2 h vs 2.25 ± 1.2 h, P < 0.05; time percent: 38.3 ± 20.6 vs 20.8 ± 18.9, P < 0.05)]. However, the above data showed that there was no significant difference between PMs and EMs in the RAB and ESO groups. The duration of nocturnal acid breakthrough in both the RAB and ESO groups was shorter than that in the OME group (3.08 ± 2.12 h and 2.98 ± 2.73 h vs 4.50 ± 2.86 h, both P < 0.05), but the pH was higher (2.15 ± 0.70 and 2.45 ± 0.65 vs 1.15 ± 0.31, both P < 0.001). There was no significant difference between the RAB and ESO groups for the above parameters.

CONCLUSION: The acid-suppression efficacy of OME is highly dependent on the CYP2C19 genetic polymorphism, while the CYP2C19 genetic polymorphism appears to have little influence on the acid-suppression efficacy of RAB and ESO. The acid-suppression of RAB and ESO are superior to that of OME, especially for night acid secretion.

Expression of c-fos in gastric myenteric plexus and spinal cord of rats with cervical spondylosis

AIM: To determine the expression of c-fos in gastric myenteric plexus and spinal cord of rats with cervical spondylosis and its clinical significance.

METHODS: A cervical spondylosis model was established in rats by destroying the stability of cervical posterior column, and the cord segments C_4-6 and gastric antrum were collected 3, 4 and 5 mo after the operation. Rats with sham operation were used as controls. c-fos neuronal counter-staining was performed with an immunohistochemistry method. Every third sections from C_4-6 segments were drawn. The 10 most labeled c-fos-immunoreactive (Fos-IR) neurons were counted, and the average number was used for statistical analysis. The mean of Fos-IR neurons in myenteric plexus was calculated after counting Fos-IR neurons in 25 ganglia from each antral preparation, and expressed as a mean count per myenteric ganglion.

RESULTS: There were a few c-fos-positive neurons in the cervical cord and antrum in the control group. There was an increased c-fos expression in model group 3, 4 and 5 mo after operation, whereas there was no significant increase in c-fos expression in the control group at 3, 4 and 5 mo. More importantly, there was a significant difference in c-fos expression between rats followed up for 3 mo and those for 5 mo in the model group (11.20±2.26 vs 27.68±4.36, P<0.05, for the cervical cord; and 11.3±2.3 vs 29.3±4.6, P<0.05, for the gastric antrum). There was no significant difference between rats followed up for 3 mo and those for 4 mo and between rats followed up for 4 mo and those for 5 mo in the model group.

CONCLUSION: c-fos expression in gastric myenteric plexus was dramatically associated with that in the spinal cord in rats with cervical spondylosis, suggesting that the gastrointestinal function may be affected by cervical spondylosis. If this hypothesis is confirmed by further studies, functional gastrointestinal diseases such as functional dyspepsia and irritable bowel syndrome could be explained by neurogastroenterology.

Effect of a single oral dose of rabeprazole on nocturnal acid breakthrough and nocturnal alkaline amplitude

AIM: To study the effect of rabeprazole (RAB) on nocturnal acid breakthrough (NAB) and nocturnal alkaline amplitude (NAKA) and to compare it with omeprazole (OME) and pantoprazole (PAN).

METHODS: By an open comparative study, forty patients with active peptic ulcer were randomly assigned to receive one of the three PPIs (proton pump inhibitor) with a single oral dose. They were divided into RAB group (10 mg), OME group (20 mg) and PAN group (40 mg). Twenty healthy volunteers were enrolled to the control group (without taking any drug). Intragastric pH monitoring was then performed 1 h before and 24 h after the dose was given.

RESULTS: No clinically undesirable signs and symptoms possibly attributed to the administration of RAB or OME and PAN were recognizable throughout the study period. All subjects completed the study according to the protocol. All data were processed by a computer using the Student t test or t’ test followed by an analysis of covariance. P < 0.05 was considered to have statistical significance. The intragastric pH of NAB was significantly higher in RAB group (1.84 ± 0.55) than in either OME group (1.15 ± 0.31) or PAN group (1.10 ± 0.30) (both P < 0.01). RAB produced a longer sustaining time (4.65 ± 1.22 h) on NAKA than OME (3.22 ± 1.89 h) (P < 0.05), PAN (3.15 ± 1.92 h) (P < 0.05), and the sustaining time of NAKA in RAB group was longer than that in the healthy control group (P < 0.01) too. In addition, RAB produced a much higher pH on NAKA (6.41 ± 0.45) in comparison with PAN (6.01 ± 0.92) (P < 0.05).

CONCLUSION: A single oral dose of 10 mg RAB may increase the pH of NAB and shorten the sustaining time of NAB, and it may increase the pH of NAKA as well as prolong the sustaining time of NAKA.

[Effect of adrenomedullin on mesenteric microvessels and microlymphatics in rat]

The dilatant effect of adrenomedullin (ADM), a novel peptide of 52 amino acids, on the mesenteric microvessels and microlymphatics was investigated under microscopic observation. 10(-6) mol/L ADM could also ameliorate alteration of the hemorheology induced by 10(-5) mol/L norepinephrine (NE) or 10(-7) mol/L endothelin (ET). However, this ameliorative response was markedly inhibited in the presence of NG-nitro-L-arginine (L-NNA), an inhibitor for production of nitric oxide.