Angelica dahurica extract and its effective component bergapten alleviated hepatic fibrosis by activating FXR signaling pathway

Angelica dahurica (A. dahurica) has a wide range of pharmacological effects, including analgesic, anti-inflammatory and hepatoprotective effects. In this study, we investigated the effect of A. dahurica extract (AD) and its effective component bergapten (BG) on hepatic fibrosis and potential mechanisms. Hepatic fibrosis was induced by intraperitoneal injection with carbon tetrachloride (CCl4) for 1 week, and mice were administrated with AD or BG by gavage for 1 week before CCl4 injection. Hepatic stellate cells (HSCs) were stimulated by transforming growth factor-β (TGF-β) and cultured with AD, BG, GW4064 (FXR agonist) or Guggulsterone (FXR inhibitor). In CCl4-induced mice, AD significantly decreased serum aminotransferase, reduced excess accumulation of extracellular matrix (ECM), inhibited caspase-1 and IL-1β, and increased FXR expressions. In activated HSCs, AD suppressed the expressions of α-SMA, collagen I, and TIMP-1/MMP-13 ratio and inflammatory factors, functioning as FXR agonist. In CCl4-induced mice, BG significantly improved serum transaminase and histopathological changes, reduced ECM excessive deposition, inflammatory response, and activated FXR expression. BG increased FXR expression and inhibited α-SMA and IL-1β expressions in activated HSCs, functioning as GW4064. FXR deficiency significantly attenuated the decreasing effect of BG on α-SMA and IL-1β expressions in LX-2 cells. In conclusion, AD could regulate hepatic fibrosis by regulating ECM excessive deposition and inflammation. Activating FXR signaling by BG might be the potential mechanism of AD against hepatic fibrosis.

Sesamol as a potential candidate for the treatment of hepatic fibrosis, based on its regulation of FXR/LXR axis-mediated inhibition of autophagy through crosstalk between hepatic cells and macrophage

BACKGROUND

Sesamol (SEM), a natural lignan compound isolated from sesame, has strong anti-oxidant property, regulating lipid metabolism, decreasing cholesterol and hepatoprotection. However, its anti-hepatic fibrosis effect and mechanisms have not been comprehensively elucidated.

HYPOTHESIS/PURPOSE

This study aims to investigate the anti-hepatic fibrosis of SEM and its underlying mechanisms.

METHOD

C57BL/6 mice with hepatic fibrosis were induced by TAA, then administrated with SEM or curcumin, respectively. HSCs were stimulated by TGF-β or conditioned medium, and then cultured with SEM, GW4064, GW3965, Rapamycin (RA) or 3-methyladenine (3-MA), respectively. Mice with hepatic fibrosis also were administrated with SEM, RA or 3-MA to estimate the effect of SEM on autophagy.

RESULTS

In vitro, SEM significantly inhibited extracellular matrix deposition, P2 × 7r-NLRP3, and inflammatory cytokines. SEM increased FXR and LXRα/β expressions and decreased MAPLC3α/β and P62 expressions, functioning as 3-MA (autophagy inhibitor). In vivo, SEM reduced serum transaminase, histopathology changes, fibrogenesis, autophagy markers and inflammatory cytokines caused by TAA. LX-2 were activated with conditioned medium from LPS-primed THP-1, which resulted in significant enhance of autophagy markers and inflammatory cytokines and decrease of FXR and LXRα/β expressions. SEM could reverse above these changes and function as 3-MA, GW4064, or GW3965. Deficiency of FXR or LXR attenuated the regulation of SEM on α-SMA, MAPLC3α/β, P62 and IL-1β in activated LX-2. In activated THP-1, deficiency of FXR could decrease the expression of LXR, and vice versa. Deficiency of FXR or LXR in activated MΦ decreased the expressions of FXR and LXR in activated LX-2. Deficiency FXR or LXR in activated MΦ also attenuated the regulation of SEM on α-SMA, MAPLC3α/β, P62, caspase-1 and IL-1β. In vivo, SEM significantly reversed hepatic fibrosis via FXR/LXR and autophagy.

CONCLUSION

SEM could regulate hepatic fibrosis by inhibiting fibrogenesis, autophagy and inflammation. FXR/LXR axis-mediated inhibition of autophagy contributed to the regulation of SEM against hepatic fibrosis, especially based on involving in the crosstalk of HSCs-macrophage. SEM might be a prospective therapeutic candidate, and its mechanism would be a new direction or strategy for hepatic fibrosis treatment.

Exploration of gastric carcinogenesis from the relationship between bile acids and intestinal metaplasia and intragastric microorganisms (H. pylori and non-H. pylori)

Gastric cancer (GC) is a prevalent form of cancer, with Helicobacter pylori (H. pylori) infection being the most common risk factor. Recent studies have highlighted the role of long-term irritation of the gastric mucosa caused by bile reflux in the development of cancer. Bile acids (BAs), which are a significant component in bile reflux, have the potential to promote gastric carcinogenesis through various mechanisms. These mechanisms include the induction of intestinal metaplasia (IM), inhibition of H. pylori activity, modification of H. pylori colonization, and alteration of the abundance and composition of microorganisms in the stomach. Defining the mechanism of bile acid-induced gastric carcinogenesis could potentially be an effective approach to prevent GC. Hence, this paper aims to review the mechanism of bile acid-induced IM, the association between BAs and H. pylori infection as well as microorganisms in the stomach, and the correlation between BAs and gastric carcinogenesis. The ultimate goal is to elucidate the role of BAs in the development of GC.

Can vitamin B6 alleviate the adverse reactions of quadruple anti-Helicobacter pylori regimen? : randomized controlled trial

BACKGROUND

Vitamin B6 is an essential water-soluble vitamin for humans. It is often used to prevent a variety of neuropathies, relieve vomiting, and relieve symptoms such as hand and foot neuritis.

AIM

To evaluate whether vitamin B6 can alleviate the adverse reactions caused by the quadruple anti-Helicobacter pylori treatment regimen containing minocycline and metronidazole.

METHODS

In this randomized controlled trial, 280 patients with H. pylori infection were randomly placed into one of two treatment groups-the conventional treatment group and the vitamin B6 supplement treatment group-for 2 weeks. The primary endpoint was the total incidence of adverse reactions up to 2 weeks after treatment initiation. The study was designed according to CONSORT Medicinal Interventions. And it was registered with Chinese Clinical Trial Registry under the number ChiCTR2100053833.

RESULTS

In terms of efficacy, vitamin B6 does not affect the efficacy of conventional regimen. In the vitamin B6 supplement treatment group, the incidence of adverse reactions was 56.92%, which was significantly lower than the 74.62% observed in the conventional treatment group. In addition, the severity of adverse reactions was also significantly reduced. The proportion of moderate to severe central nervous system symptoms decreased from 58.7 to 14.63%. And, the proportion of moderate to severe gastrointestinal reactions decreased from 33.33 to 0%. We speculate that the mechanism of vitamin B6 of reducing adverse reaction may be related to the production of GABA in the brain.

CONCLUSIONS

Vitamin B6 can alleviate adverse reactions of the quadruple anti-H. pylori regimen containing minocycline and metronidazole.

The impact of Helicobacter pylori infection and eradication therapy containing minocycline and metronidazole on intestinal microbiota

BACKGROUND

Helicobacter pylori (H. pylori) infection is associated with remodeling of gut microbiota. Many studies have found H. pylori infection and eradication therapy can alter the gut microbiota. However, few studies explored the impact of eradication therapy containing minocycline and metronidazole on gut microbiota.

AIM

The objective of the present study was to explore the changes of gut microbiota after H. pylori infection. Besides, learn more about the dynamic changes of gut microbiota during different stages of eradication treatment containing minocycline, metronidazole, bismuth agents and proton pump inhibitors.

METHODS

Sixty stool samples from the patients with H. pylori infection before eradication, 14 and 42 days after eradication, and ten stool samples from non-infected individuals were collected. Subsequently, we performed 16S rRNA gene amplicon sequencing to analyze these samples, and the results were evaluated by using alpha diversity, beta diversity and microbial composition analyses. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States was also used to predict the metabolic pathways according to the Kyoto Encyclopedia of Genes and Genomes database.

RESULTS

The alpha and beta diversity of the microbiota changed significantly in H. pylori infected individuals, but returned to baseline 42 days after eradication therapy. At the genus level, the abundances of Bacteroidetes, [Ruminococcus]_gnavus_group, Ruminococcaceae_Incertae_Sedis, Tuzzrealla, Butyricicoccus were significantly lower in the H. pylori infected group. Bacterial abundance was also dynamically changing during eradication treatment. In addition, PICRUST analysis found the levels of uronic acid metabolism, uncharacterized transport system, and biosynthesis of unsaturated fatty acids were higher in H. pylori infected individuals than in the non-infected group.

CONCLUSIONS

Intestinal microbiota diversity, composition, functional predictions altered significantly after H. pylori infection, and gradually returned to healthy control levels after the application of eradication therapy containing minocycline and metronidazole in one month and a half.

Acanthoic acid, unique potential pimaradiene diterpene isolated from Acanthopanax koreanum Nakai (Araliaceae): A review on its pharmacology, molecular mechanism, and structural modification

Acanthoic acid (AA) is a pimaradiene diterpene isolated from the root bark of Acanthopanax koreanum Nakai (Araliaceae) with a wide range of pharmacological activities, including anti-cancer, anti-inflammatory, anti-diabetes, liver protection, gastrointestinal protection, and cardiovascular protection. In addition, AA promotes its pharmacological effects by targeting liver X receptors (LXRs), nuclear factor-kappa B (NF-κB), Toll-Like Receptor 4 (TLR4) and IL-1 receptor-associated kinase (IRAK) signaling pathways, or AMP-activated protein kinase (AMPK) signaling pathway, etc. Also, some studies focus on the structural modification of AA to improve its pharmacological activities. The review summarizes the pharmacological activities, molecular mechanism, and the structural modification of AA, which might supply information for the development of AA in the future.

[Effect evaluation of "Smoking cessation: Doctor first"program in China]

Objective: To evaluate the effect of "Smoking cessation: Doctor first" program on smoking medical staff. Methods: From December 2016 to September 2019, 1 747 smoking medical staff from 54 units of China Tobacco Cessation Alliance were enrolled into"Smoking cessation: Doctor first"program. Demographic characteristics, smoking characteristics, degree of tobacco dependence, willingness to quit smoking and other related factors were collected during the baseline survey. Multivariate logistic regression model was used to analyze the related factors of willingness to quit. The subjects were given intensive smoking cessation intervention from October 2017 to September 2019, including education on the hazards of smoking, methods of smoking cessation and giving smoking cessation drugs. After intervention, the subjects were investigated about their smoking cessation progress and the effect of the project was evaluated. Results: The subjects were (41±11) years old, 91.9% (1 609/1 747) were male and 62.2% (1 086/1 747) were daily smokers. The main reasons for smoking included the influence of friends [697 (39.9%)], the need for social entertainment [629 (36.0%)], the relief of mental stress [589 (33.7%)] and the refreshment [459 (26.3%)]. At baseline, 52.9% (885/1 672) and 43.2% (755/1 747) smokers had intention to quit smoking and had planned to quit within one year, respectively. Multivariate logistic regression model analysis showed that: low education level [OR (95%CI) of high school and junior high school and below were 2.42 (1.61, 3.63) and 1.57 (1.18, 2.11)], daily smoking [OR (95%CI): 1.38 (1.06, 1.78)], thinking quitting smoking is not important [OR (95%CI): 4.15 (3.33, 5.18)] and having no quitting experience [OR (95%CI): 3.21 (2.53, 4.05)] were associated with no intention to quit smoking. After intensive smoking cessation intervention, 81.0% (1 415/1 747) smokers started to quit and 36.6% (518/1 415) quit smoking with drugs, both higher than the baseline level (all P values<0.001). By the end of the program, 60.2% (852/1 415) of the medical staff had quit smoking successfully. Conclusion: "Smoking cessation: Doctor first"program can improve the willingness to quit and the proportion of using smoking cessation drugs of medical staff.

Modulation of IL-36-based inflammatory feedback loop through hepatocytes-derived IL-36R-P2X7R axis improves steatosis in alcoholic steatohepatitis

BACKGROUND AND PURPOSE

IL-36 is induced by proinflammatory cytokines and itself promotes inflammatory responses, shaping an IL-36-based inflammation loop. Although, hepatocytes, as "epithelial cell-like" hepatic parenchymal cells, produce IL-36 responses to drug-induced liver injury, little is known about the mechanistic role of the IL-36 signalling during the progression of alcoholic steatohepatitis (ASH). Regarding IL-36/IL-36R and P2X7R coregulates the inflammatory response, we elucidated the modulation of IL-36R-P2X7R-TLRs axis affected hepatocytes steatosis and IL-36-based inflammatory feedback loop that accompanies the onset of ASH.

EXPERIMENTAL APPROACH

C57BL/6J mice were subjected to chronic-plus-binge ethanol feeding or acute gavage with multiple doses of ethanol to establish ASH, followed by pharmacological inhibition or genetic silencing of IL-36R and P2X7R. AML12 cells or mouse primary hepatocytes were stimulated with alcohol, LPS plus ATP or Poly(I:C) plus ATP, followed by silencing of IL-36γ, IL-36R or P2X7R.

KEY RESULTS

P2X7R and IL-36R deficiency blocked the inflammatory loop, especially made by IL-36 cytokines, in hepatocytes of mice suffering from ASH. Pharmacological inhibition to P2X7R or IL-36R alleviated lipid accumulation and inflammatory response in ASH. IL-36R was indispensable for P2X7R modulated NLRP3 inflammasome activation in ASH and IL-36 led to a vicious cycle of P2X7R-driven inflammation in alcohol-exposed hepatocytes. TLR ligands promoted IL-36γ production in hepatocytes based on the synergism of P2X7R.

CONCLUSIONS AND IMPLICATIONS

Blockade of IL-36-based inflammatory feedback loop via IL-36R-P2X7R-TLRs-modulated NLRP3 inflammasome activation circumvented the steatosis and inflammation that accompanies the onset of ASH, suggesting that targeting IL-36 might serve as a novel therapeutic approach to combat ASH.

Protective role of Siberian onions against toxin-induced liver dysfunction: an insight into health-promoting effects

Siberian onions (SOs) are delicious wild vegetables. Their taste is most unique, not only like scallions but also like leeks or garlic. They also have a traditional medicinal value for anti-inflammation, anti-oxidation, and anti-pyretic analgesia, particularly facilitating hepatoprotective effects. The current study investigates the potential mechanism of SOs against toxin-induced liver dysfunction. BALB/c mice were administrated with SO or silymarin by oral gavage for one week, followed by injecting carbon tetrachloride (CCl₄) to induce hepatic fibrosis. The effect of SO against hepatic fibrosis was evaluated by examining the liver tissue for serum transaminase, oxidative stress, extracellular matrix, histological alterations, cytokine levels, and apoptosis. In vitro, HSC-T6 cells were cultured with the supernatant from Raw 264.7 cells stimulated with lipopolysaccharides, followed by SO extracts or Niclosamide (Signal Transducer and Activator of Transcription 3 (STAT3) inhibitor) at indicated time periods and doses. SO decreased serum transaminase levels and oxidative stress, and regulated the balance of ECM in CCl₄-induced mice, including α-SMA, collagen-I and TIMP-1. SO reduced the release of inflammatory factors and regulated apoptosis-associated proteins, which is related to the inhibition of STAT3 phosphorylation. Moreover, SO reduced the positive expressions of α-SMA and NLRP3 by inhibiting STAT3 phosphorylation in activated HSCs. SO could show health-promoting effects for liver dysfunction by alleviating hepatic fibrogenesis, apoptosis and inflammation in the development of hepatic fibrosis potential depending on the STAT3 signaling pathway.

Inhibition of HMGB1/TLR4 Signaling Pathway by Digitoflavone: A Potential Therapeutic Role in Alcohol-Associated Liver Disease

Digitoflavone (DG) is a natural flavonoid abundant in many fruits, vegetables, and medicinal plants. We investigated whether DG inhibits lipid accumulation and inflammatory responses in alcoholic liver disease (ALD) in vivo and in vitro. The mouse ALD model was established by chronically feeding male C57BL/6 mice an ethanol-containing Lieber-DeCarli liquid diet. In vitro, mouse peritoneal macrophages (MPMs) and mouse bone marrow-derived macrophages (BMDMs) were stimulated with LPS/ATP, whereas HepG2 cells and mouse primary hepatocytes were treated with ethanol. DG reduced the serum levels of transaminase and serum and hepatic levels of triglycerides and malondialdehyde in ALD mice. DG downregulated SREBP1 and its target genes and upregulated PPARα and its target genes in the liver of mice with ALD. DG inhibited TLR4-mediated NLRP3 inflammasome activation, consequently reversing the inflammatory response, including the production of HMGB1, IL-1β, and IL-36γ, as well as the infiltration of macrophages and neutrophils. DG blocked NLRP3/ASC/caspase-1 inflammasome activation and HMGB1 release in LPS/ATP-stimulated MPMs. When Tlr4 was knocked in LPS/ATP-stimulated BMDMs, HMGB1 production and release were blocked, and NLRP3-mediated cleavage and release of IL-1β was suppressed in Hmgb1-silenced BMDMs. DG amplified these inhibitory effects in Tlr4 or Hmgb1 knockdown BMDMs. In ethanol-exposed hepatocytes, DG reduced lipogenesis and promoted lipid oxidation by inhibiting the HMGB1-TLR4 signaling pathway while suppressing the inflammatory response induced by ethanol exposure. Our data demonstrated that DG inhibited the occurrence of lipid accumulation and the inflammatory response via the HMGB1-TLR4 axis, underscoring a promising approach and utility of DG for the treatment of ALD.

Mucosal bacterial dysbiosis in patients with nodular lymphoid hyperplasia in the terminal ileum

BACKGROUND

Nodular lymphoid hyperplasia (NLH) in the small intestine is a rare benign lesion characterized by multiple small nodules on the intestinal surface. Patients with terminal ileal NLH may experience long-term abdominal pain, diarrhea, and abdominal distension, among other symptoms. Supplementation with probiotics could mitigate these symptoms. NLH is linked to the immune system, and it may result from accumulation of plasma-cell precursors due to a maturational defect during the development of B lymphocytes. The intestinal microbiome plays an essential role in the immune system. Thus, we speculate that the gut flora plays a key role in terminal ileal NLH.

AIM

To explore the correlation between intestinal flora and terminal ileal NLH.

METHODS

We collected mucosal biopsy samples that were obtained via colonoscopy from 15 patients with terminal ileal NLH (the test group) and 15 normal subjects (the control group). We subsequently performed 16S-rRNA gene amplicon sequencing of these samples, and the results were evaluated using alpha diversity, beta diversity and microbial composition analyses. The Phylogenetic Investigation of Communities by Reconstruction of Unobserved States was used to predict the metabolic pathways and orthologous groups according to the Kyoto Encyclopedia of Genes and Genomes database.

RESULTS

Compared with the control group, the terminal ileal NLH group showed an increased alpha diversity (P < 0.05). The overall intestinal microbiota in the NLH group was significantly different from that of the control group (P < 0.05), implying that there was the dysbiosis in the terminal ileal NLH patients. The relative abundance of phylum Bacteroidetes was significantly lower in the NLH group, while that of Patescibacteria and Campilobacterota was significantly higher. The genus Bacteroides was the dominant gut microbiota in both groups, but its abundance was significantly lower in the test group than it was in the control group. Conversely, the relative abundances of Haemophilus, Streptococcus, Pseudomonas, Actinomyces, TM7X, Fusobacterium nucleatum, Parvimonas, Granulicatella, Helicobacter, and the [Eubacterium] nodatum group were significantly higher in the test group than they were in the control group. In addition, several altered metabolic pathways, orthologous groups, and modules were found. For example, the Peptidoglycan biosynthesis and Aminoacyl tRNA biosynthesis were both increased in the test group.

CONCLUSION

Maintaining the microbial balance and supplementing targeted protective bacteria could improve symptoms and potentially reduce the risk of lymphoma transformation in patients with terminal ileal NLH.

Efficacy evaluation of Lattice Carbon Dioxide Laser Therapy in the treatment of postmenopausal patients with mild to moderate stress urinary incontinence

Objectives

To investigate the efficacy and postoperative complications of lattice carbon dioxide laser in the treatment of postmenopausal patients with mild to moderate stress urinary incontinence.

Methods

A total of 30 postmenopausal female patients with mild to moderate stress urinary incontinence, recruited from the Affiliated Hospital of Hebei University from September to November 2019, were selected as the study subjects and treated with lattice carbon dioxide laser therapy. Treatment was given at intervals of one month. The degree of urinary incontinence, the urinary incontinence questionnaire (ICI-Q-SF) score, and the urinary incontinence quality of life scale (I-QOL)) Score, surgical satisfaction, one hour pad test and postoperative complications before treatment and after each treatment of all patients were respectively recorded and compared.

Results

Compared with those before treatment, the grade of urinary incontinence and ICI-Q-SF scores of these 30 patients after each treatment were lower, and their I-QOL scores were higher. The difference of one hour urine pad test was statistically significant (P<0.05), but the follow-up data of three months after the third treatment was close to that of one month after the first treatment. The satisfaction rate of these 30 patients was 76.67% (23/30). After treatment, only one patient presented vaginal itching discomfort on the first day after surgery and the symptoms disappeared three days later. No obvious complications occurred in the other 29 patients.

Conclusion

The treatment of mild and moderate postmenopausal patients with stress urinary incontinence with lattice carbon dioxide laser can effectively reduce the incidence of incontinence and improve the quality of life.

Luteolin attenuates hepatic injury in septic mice by regulating P2X7R-based HMGB1 release

P2X7 receptor (P2X7R) and NLRP3 cooperatively participate in inflammation and hepatocyte damage during hepatic injury induced by lipopolysaccharides (LPS). High-mobility group box 1 (HMGB1) released from immune cells in response to such stimuli plays a vital role in mediating inflammation via TLR4 and the receptor for advanced glycation end products (RAGE), a receptor for HMGB1. However, the correlation among P2X7R, RAGE and TLR4 in regulating the release of HMGB1 has not been elucidated. Increasing the number of daily foods is found to be beneficial for hepatocyte damage in septic hepatic injury. Hence, we investigated the effects of luteolin, a natural flavonoid mainly existing in vegetables and fruits, on liver injury, focusing on how luteolin participates in hepatitis based on the P2X7R-RAGE-TLR4 axis by regulating the release of HMGB1. The results demonstrated that the indicators of hepatic injury such as increased ALT, AST in the serum and infiltration of immune cells were attenuated after luteolin treatment in LPS-induced mice. Luteolin could also suppress the production and release of HMGB1 and the activation of caspase 1 both in LPS-induced mice and LPS/ATP-stimulated HepG2 cells. Collectively, luteolin reversed LPS-induced hepatic injury, especially inflammation, likely by regulating the release of HMGB1 through the P2X7R-RAGE-TLR4 axis.

Allium victorialis L. Extracts Promote Activity of FXR to Ameliorate Alcoholic Liver Disease: Targeting Liver Lipid Deposition and Inflammation

Allium victorialis L. (AVL) is a traditional medicinal plant recorded in the Compendium of Materia Medica (the Ming Dynasty). In general, it is used for hemostasis, analgesia, anti-inflammation, antioxidation, and to especially facilitate hepatoprotective effect. In recent years, it has received more and more attention due to its special nutritional and medicinal value. The present study investigates the effect and potential mechanism of AVL against alcoholic liver disease (ALD). C57BL/6 mice were fed Lieber-DeCarli liquid diet containing 5% ethanol plus a single ethanol gavage (5 g/kg), and followed up with the administration of AVL or silymarin. AML12 cells were stimulated with ethanol and incubated with AVL. AVL significantly reduced serum transaminase and triglycerides in the liver and attenuated histopathological changes caused by ethanol. AVL significantly inhibited SREBP1 and its target genes, regulated lipin 1/2, increased PPARα and its target genes, and decreased PPARγ expression caused by ethanol. In addition, AVL significantly enhanced FXR, LXRs, Sirt1, and AMPK expressions compared with the EtOH group. AVL also inhibited inflammatory factors, NLRP3, and F4/80 and MPO, macrophage and neutrophil markers. In vitro, AVL significantly reduced lipid droplets, lipid metabolism enzymes, and inflammatory factors depending on FXR activation. AVL could ameliorate alcoholic steatohepatitis, lipid deposition and inflammation in ALD by targeting FXR activation.

Modulation of HMGB1 Release in APAP-Induced Liver Injury: A Possible Strategy of Chikusetsusaponin V Targeting NETs Formation

Acetaminophen (APAP), one of the most common antipyretic analgesics, which is safe at therapeutic dose, cause acute liver injury and even death at overdose. However, the mechanism of APAP-induced inflammation in liver injury is still controversial. Therefore, effective drug intervention is urgently needed. The aim of this study was to explore the inflammatory exact mechanism of APAP, especially on neutrophils, and to study the intervention effect of Chikusetsusaponin V (CKV) derived from Panax japonicus. Establishment of hepatotoxicity model of APAP in vitro and in vivo. In vitro, HepG2 cells, AML12 cells, primary mouse hepatocytes and neutrophils were used to mimic APAP-affected hepatocytes and neutrophil. In vivo, C57BL/6 mice were administrated overdose of APAP with or without neutrophil depletion or abolishing neutrophil extracellular traps (NETs) formation. In this study, APAP stimulation increased the level of HMGB1, IL-1β and Caspase-1 in mouse liver, especially hepatocytes, which had a synergistic effect with LPS/ATP combination. NETs were formatted at early stage of APAP or HMGB1-stimulated neutrophils’ damage. Conditioned mediums from APAP-treated hepatocytes induced more significant NETs than direct APAP stimulation. Neutrophil depletion or abolishing NETs formation decreased HMGB1 level, eventually blocked hepatocytes necrosis. CKV pretreatment interfered Caspase-1 activation and HMGB1 release in APAP-damaged hepatocytes. CKV also prevented NETs formation. These results indicate that the production of HMGB1 may depend on the activation of Caspase-1 and play a key role in liver inflammation caused by APAP. The cross-dialogue between hepatocytes and neutrophils can be mediated by HMGB1. Therefore, CKV has a positive intervention effect on NETs-related inflammation in APAP-damaged liver, targeting Caspase-1-HMGB1.

Parthenolide, bioactive compound of Chrysanthemum parthenium L., ameliorates fibrogenesis and inflammation in hepatic fibrosis via regulating the crosstalk of TLR4 and STAT3 signaling pathway

The current study focused on the regulatory effects of parthenolide (PNL), a bioactive component derived from Chrysanthemum parthenium L., against hepatic fibrosis via regulating the crosstalk of toll-like receptor 4 (TLR4) and signal transducer and activator of transcription 3 (STAT3) in activated hepatic stellate cells (HSCs). HSCs or Raw 264.7 macrophages were activated by TGF-β or LPS for 1 hr, respectively, and then treated with PNL, CLI-095 (TLR4 inhibitor), or Niclosamide (STAT3 inhibitor) for the indicated time to detect the crosstalk of TLR4 and STAT3. PNL significantly decreased the expressions of α-SMA, collagen I, and the ratio of TIMP1 and MMP13 in TGF-β-activated HSCs. PNL significantly reduced the releases of pro-inflammatory cytokines, including IL-6, IL-1β, IL-1α, IL-18, and regulated signaling P2X7r/NLRP3 axis activation. PNL obviously induced the apoptosis of activated HSCs by regulating bcl-2 and caspases family. PNL significantly inhibited the expressions of TLR4 and STAT3, including their downstream signaling. PNL could regulate the crosstalk of TLR4 and STAT3, which were verified by their inhibitors in activated HSCs or Raw 264.7 cell macrophages. Thus, PNL could decrease the expressions of fibrosis markers, reduce the releases of inflammatory cytokines, and also induce the apoptosis of activated HSCs. In conclusion, PNL could bi-directionally inhibit TLR4 and STAT3 signaling pathway, suggesting that blocking the crosstalk of TLR4 and STAT3 might be the potential mechanism of PNL against hepatic fibrosis.

Single-Port Percutaneous Nephroscopy combined with GreenLight Laser in Simple Renal Cyst

Objective:

To explore the therapeutic effect of percutaneous nephroscopy combined with Green Light laser on simple renal cyst.

Methods:

A retrospective analysis was conducted to review the clinical data, surgical procedures, intraoperative bleeding, postoperative adverse reactions, and length of stay of 32 patients who had been admitted to Affiliated Hospital of Hebei University from January 2018 to February 2019. All patients had been diagnosed with simple renal cyst by imaging examination and met the surgical indications for single-port percutaneous nephroscopy combined with GreenLight laser for unroofing and decompression of the renal cyst. Among the 32 patients, there were 18 males and 14 females, with 15 cases on the left and 17 on the right. The patients aged 38 to 62 years old, with an average of 45 years old. Thirteen cases were hospitalized mainly due to complaint of lumbar pain, and 19 cases were admitted after a renal cyst was found by physical examination. The diameter of the cyst ranged from 4.2 to 9.1 cm, with an average of 6.1 cm. A percutaneous nephroscopic channel was established during the surgery. Once a nephroscope was placed into the cyst, GreenLight laser (energy of 80W) was used to remove the free cyst wall 0.3cm from the renal parenchymal margin under direct vision. After the incision margin was observed with no obvious exudation under microscope, the cyst wall was removed through the channel and sent for pathological examination. A drainage catheter was placed near the cyst cavity.

Results:

All the 32 patients were successfully operated, without transition to laparoscopic and open surgery. The operations took 30 to 62 minutes, with an average of 45 minutes. The intraoperative bleeding ranged from three to 14 ml, with an average of 10 ml. No adverse events such as postoperative infection, fever, or active bleeding occurred. The drainage catheters were removed one to three days after operation, with an average of 1.5 days after operation. The drainage volume was 20 to 55 ml, with an average of 35 ml. No obvious liquid extravasation was seen in all cases. The length of stay after operation ranged from three to five days, with an average of 3.5 days. Postoperative pathological reports all suggested renal cyst wall. The patients were followed up for six months, and no cyst recurred.

Conclusions:

Single-port percutaneous nephroscopy combined with Green Light laser could provide significant clinical effect in treating simple renal cyst with minimal trauma.

20S-Protopanaxatriol Ameliorates Hepatic Fibrosis, Potentially Involving FXR-Mediated Inflammatory Signaling Cascades

Ginseng has been used as a functional food and tonic for enhancing immune power. Here, the potential protective effect of 20S-protopanaxatriol (M4), the metabolite of protopanaxatriol, against hepatic fibrosis is investigated, which could provide nutritional interventions for disease treatment. M4 could inhibit extracellular matrix (ECM) deposition and reduce the levels of proinflammatory cytokines such as caspase 1, interleukin 1 β (IL-1β), interleukin 1 receptor type 1 (IL1R1), and interleukin 6 (IL-6). M4 also significantly increased the expression of farnesoid X receptor (FXR), suppressed the purinergic ligand-gated ion channel 7 receptor (P2X7r) signaling pathway, and works as an FXR agonist, GW4064. In thioacetamide (TAA)-induced mice, M4 could attenuate the histopathological changes and significantly regulate the expression levels of FXR and P2X7r. M4 ameliorated TAA-induced hepatic fibrosis due to the reduction of P2X7r secretion, inhibition of hepatic stellate cell (HSCs) activation, and inflammation, which were all associated with FXR activation. Hence, M4 might be useful a nutritional preventive approach in antihepatic fibrosis and antihepatic inflammation.

Treatment of renal calculi without hydronephrosis using a standard channel assisted by a visual puncture system

Objective

To study the safety and efficacy of standard channel establishment using a visual puncture system in the treatment of renal calculi without hydronephrosis.

Methods

We retrospectively analyzed data from 46 patients undergoing percutaneous nephrolithotomy via a standard channel assisted by a visual puncture system, including number of punctures, duration of procedure, hemoglobin level after surgery, calculi clearance rate, and postoperative complications.

Results

Sixty-nine channels were established, including a single channel in 26 cases, double channel in 17 cases, and three channels in 3 cases. The mean number of punctures was 1.50, mean time to establish the standard channel was 2.6 minutes, and duration of surgery was 31.3 minutes. No significant change in hemoglobin was observed after surgery. Forty-three patients had no residual calculi and three had small residual calculi on the day after surgery, representing a first-phase clearance rate of 93.48% (43/46). No significant complications were observed.

Conclusions

Hemorrhage during operation can be significantly reduced by establishing a standard channel using a visual puncture system. Moreover, the number of standard channels can be reduced and the incidence of complications lowered using this approach, which should be adopted widely for the treatment of renal calculi without hydronephrosis.

[Analysis of sleep quality of a prison police]

Objective: To investigate the sleep quality of prison policemen and explore its influencing factors, so as to provide reference for improving the sleep quality of prison policemen. Methods: In August 2013, 177 policemen in a prison were selected by cluster sampling. The sleep quality of 177 prison policemen was investigated by Pittsburgh Sleep Quality Index Scale and General Situation Questionnaire, and the influencing factors were analyzed. Results: The PSQI scores of 177 prison policemen were (7.47+3.80). There were significant differences between the PSQI scores of prison policemen and the normal adult norm (P<0.05). According to the standard of poor sleep quality, 84 prison policemen (47.46%) had poor sleep quality, and the prison policemen scored higher on daytime dysfunction, subjective sleep quality, sleeping time and sleeping time components. Single factor t test and single factor variance analysis showed that there were significant differences in sleep quality among prison policemen in gender, age, educational level and job classification (P <0.05). The results of multiple stepwise regression analysis showed that gender, age and job classification entered the regression equation with PSQI total score as dependent variable (β=0.167, 0.270, 0.222) . Conclusion: The sleep quality of prison policemen is worse than that of normal adults, and is affected by gender, age, job classification and other factors, which should be paid attention to by prison administrators.

Impact of Curative Effect of Laparoscopic and Open Partial Nephrectomy for Complex Renal Tumours on Renal Function

OBJECTIVE

To explore the effect and safety of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the treatment of complex renal tumours and to compare renal function in the perioperative period.

STUDY DESIGN

Comparative study.

PLACE AND DURATION OF STUDY

Departments of Urology and Cardiovascular Medicine, Affiliated Hospital of Hebei University, from July 2016 to June 2018.

METHODOLOGY

A total of 168 complex renal tumour patients with renal tumour scoring system scores (R.E.N.A.L) <7 and tumour stages of T1aN0M0~TlbN0M0 (diameter of tumour <7 cm without metastasis) were chosen. The patients were classified into the retroperitoneal laparoscopic partial nephrectomy (RLPN) group and open partial nephrectomy (OPN) group, comprising 84 patients in each group. Intraoperative and postoperative characteristics of both groups were compared. Statistical analysis of the occurrence rate of postoperative complications was conducted. Renal function indicators, including serum urea (UREA), creatinine (Cr), uric acid (UA) and glomerular filtration rate (GFR), were evaluated one day before the operation and one week after the operation.

RESULTS

The differences between the two groups in intraoperative renal warm ischaemia time (WIT) and postoperative drainage time were not statistically significant. Compared with OPN group, RLPN group had shorter recovery time of gastrointestinal function, less use of analgesics and longer hospital stay. The difference in the recent occurrence rate of complications was not statistically significant. The differences between the two groups in UREA, Cr, UA and GFR one day before the operation and one week after the operation were not statistically significant (p>0.05). The Cr and UA levels of both groups improved significantly after the operation, and the GFR level declined significantly. The differences were statistically significant compared with preoperation levels (p<0.05).

CONCLUSION

The effect and safety of RLPN in the treatment of complex renal tumours are equal to those of open operations. Laparoscopic surgery involves a small operative wound and contributes to renal function recovery, allowing patients to recover quickly; however, laparoscopic surgery has high technical requirements for its operators.

[Effects of ketotifen on fractional exhaled nitric oxide in patients with combined allergic rhinitis and asthma syndrome]

Objective:To study effects of ketotifen on fractional exhaled nitric oxide in patients with combined allergic rhinitis and asthma syndrome.Method:One hundred and twelve patients with asthma were selected from department of respiration, Affiliated Hospital of North China University of science and technology from January 2016 to 2017 in March. Eighty-four patients with allergic rhinitis were selected as the subjects, Randomly divided into two groups,including observed group(n=42) and control group(n=42).The control group was treated with antitussive,expectorant and inhaled corticosteroids, while the observed group in the control group combined with ketotifen 1 mg 2/ day oral treatment,the changes of FeNO and IL-17 in the two groups were compared after one month treament.Result:Before treatment, two groups of patients in general IL-17 and fractional exhaled nitric oxide ware no significant difference(P> 0.05).After treatment, compared to the control group, the observed group was significantly more effective,the difference was statistically significant(P <0.05);fractional exhaled nitric oxide in treatment group were lower than those in control group, the difference was statistically significant(P&lt;0.05,P< 0.01).And the observed group was lower than the control group, and the differences were statistically significant,t(P<0.05).Conclusion:Ketotifen significantly reduce the FeNO of allergic rhinitis and asthma syndrome, reduce airway inflammation.

[A survey of sleep quality of employed nurses in military hospitals]

Objective: To investigate the sleep quality of the employed nurses in three grade A tertiary military hospitals in Beijing, China and its influential factors and to provide a reference for improving the sleep quality of employed nurses. Methods: From January 2014 to January 2017, a questionnaire survey was carried out to investigate the sleep quality of 253 employed nurses in three grade A tertiary military hospitals in Beijing, China using the Pittsburgh Sleep Quality Index (PSQI) and a general status questionnaire. The results were compared with the adult norms to analyze the influential factors for sleep quality of the employed nurses. Results: The global PSQI score of the 253 employed nurses was 7.76 ± 3.53. Their global PSQI score and PSQI component scores were significantly higher than the adults norms (P<0.05) . And 54.94% of the employed nurses had poor sleep quality; they had high scores of daytime dysfunction (1.39±0.83) , sleep latency (1.67±0.94) , sleep quality (1.33±0.88) , and sleep time (1.23±0.78) . The one-way analysis of variance showed that the sleep quality of the employed nurses was associated with nursing age, educational background, professional title, whether to have children, frequency of night shifts, and department (P<0.05) . The multivariate logistic regression analysis showed that the risk factors for sleep quality of the employed nurses were technical secondary school education (OR=4.292) and emergency department and intensive care unit (OR=2.582) ; the protective factors for sleep quality of the employed nurses were outpatient department and assistant department (OR=0.312) , no children (OR=0.318) , and no night shift (OR=0.332) . Conclusion: The employed nurses in military hospitals have poorer sleep quality than the normal adults. The influential factors for sleep quality of employed nurses are educational background, department, whether to have children, and frequency of night shifts.

[The effect of monrustet on the exhalation of nitric oxide and inflammatory cytokines in patients with asthma combined with OSAHS]

Objective:To study the effect of monrustet on fractional exhaled nitric oxide and inflammatory cytokines in the elderly with bronchial asthma combined obstructive sleep apnea hypopnea syndrome.Method:150 cases diagnosed as asthma were enrolled in this study. The patients were divided into bronchial asthma combined with OSAHS (n=72)and bronchial asthma (n=78). According to the different treatment methods , patients were divided into observation group and control group. Two groups were given common treatment with inhaled corticosteroids, and the observation group was taken orally montrast 10mg/night additionally. The fractional exhaled nitric oxide was detected before and after treatment. Serum were collected for detection of tumor necrosis factor alpha (TNR-α), Creactive protein (CRP) and interleukin 6 (IL-6), according to the sleep monitoring results, the sleep apnea low ventilation index (AHI) was calculated, and the changes of FeNO level,CRP,TNR-α,IL-6 and AHI were analyzed in the two groups.Result:Before treatment, the gender, age, degree of disease, FeNO level,TNR-α, CRP,IL-6 and AHI differences were not statistically significant in the two groups (P>0.05).After treatment, both groups of FeNO, TNR-α,CRP,IL-6 and AHI decreased before treatment (P < 0.05).The observation group was lower than the control group, and the difference was statistically significant (FeNO level, AHIP< 0.01,TNR-α, CRP,IL-6 P< 0.05).Conclusion::Montelukast can reduce the FeNO level, the expression of TNR-α, CRP, and IL-6 of patients of bronchial asthma combined with OSAHS. Further improvement of the patient's condition, and provide reference value for the clinical medicine of patients with asthma.

[Surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors: a preclinical research of human uterine transplantation]

Objective: To evaluate the surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors.This study is a preclinical research of human living uterine transplantation. Methods: From May, 2015 to May, 2017, four uteri retrieval procedures, characterized with radical hysterectomy and uterine vascular pedicles dissection, were performed in multi-organ brain-dead donors.The uterus was the third authorized organ after the kidney and liver retrieval procedures in the first two cases.The uterine pedicles included the uterus, ovaries, fallopian tubes, the upper one-third of the vagina and internal iliac vessels or external iliac vessels.The perfusion of the uterus was conducted after the retrieval for evaluating the availability, followed by histopathological examination of the uterine issues per 30 minutes. Results: Since the uterine vein was quite difficult to identify and dissect in the first two case, which result in the rupture of triple uterine veins.Therefore, the uterine venous vessels including uterine vein connected with internal iliac vein and internal iliac arteries were selected as vascular grafts and dissected successfully in the last two cases, which could be perfused with the mixture of 4 ℃ heparinized physiological saline through each artery because of shortening the surgical time and arranging the uterine procurement as the first authorized organ procedure.Mean (SD) operative time was 152.5±39.0 min (115-215 min, n=4). Conclusion: Our preliminary experience indicated that the uterus could be retrieved from the brain-dead multi-organ donors and transplanted to the recipient.The attempt of skeletonizing the uterine veins should be replaced by dissection of internal iliac vein.

[F4.8 visual miniature nephroscope for the diagnosis and treatment of hematospermia]

OBJECTIVE

To explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia.

METHODS

This study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation.

RESULTS

Of the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10－55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6－20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication.

CONCLUSIONS

The F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.

[Role of sleep apnea monitoring management platform in the treatment of patients with obstructive sleep apnea hypopnea syndrome]

Objective:To investigate the clinical significance and value of the sleep apnea monitoring management platform in the treatment of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by comparing with the traditional continuous positive airway pressure (CPAP) card reader mode.Method:A total of 48 severe adult OSAHS patients from Department of Otorhinolaryngology Head and Neck Surgery-Sleep Medical Center of the Third People's Hospital of Honghe during the period of Nov. 2015 to Aug. 2016 were collected in this prospective study. All of them were diagnosed by PSG and treated with nasal continuous positive airway pressure. They were randomly divided into group A (n=24) and group B (n=24). Group A and B were treated with the traditional CPAP card reader mode and the sleep apnea monitoring management platform respectively. During the follow-up, the compliance, mean blood oxygen saturation, titration pressure, Epworth sleepiness scale after 1, 3, 6 and 12 month treatment were compared between two groups. Ttest was used to analyze the difference. Statistical significance was set at P <0.05.Result:Statistical analysis showed that there were significant difference in the compliance of using CPAP, mean blood oxygen saturation and Epworth sleepiness scale score between the two groups (P < 0.05), but the titration pressure had no difference between the two groups (P>0.05).Conclusion:Compared the sleep apnea monitoring management platform with traditional CPAP card reader mode in the treatment of OSAHS patients, the former could solve the problems during the CPAP use in time, improve the compliance of using CPAP, and which could increase the efficacy of CPAP. Thus, the sleep apnea monitoring management platform is of more clinical value and deserve promotion.

MicroRNA-122 regulates caspase-8 and promotes the apoptosis of mouse cardiomyocytes

Cardiomyocyte apoptosis plays key roles in the pathogenesis of heart diseases such as myocardial infarction. MicroRNAs are important regulators of gene expression, which are also involved in the regulation of cardiomyocyte apoptosis. However, cardiomyocyte apoptosis regulated by microRNA (miR)-122 is largely unexplored. The aim of this study focused on the role of miR-122 in cardiomyocyte apoptosis. Cardiomyocytes were isolated from neonatal mice and primarily cultured. MiR-122 mimic and inhibitor were transfected to cardiomyocytes and verified by qRT-PCR. Cell viability and apoptosis post-transfection were assessed by MTT assay and flow cytometry, respectively. Changes in expression of caspase-8 were quantified by qRT-PCR and western blot. Results showed that miR-122 mimic and inhibitor successfully induced changes in miR-122 levels in cultured cardiomyocytes (P<0.01). MiR-122 overexpression suppressed viability and promoted apoptosis of cardiomyocytes (P<0.05), and miR-122 knockdown promoted cell viability and inhibited apoptosis (P<0.05). The mRNA and protein levels of caspase-8 were elevated by miR-122 overexpression (P<0.01) and reduced by miR-122 knockdown (P<0.001). These results suggest an inductive role of miR-122 in cardiomyocyte apoptosis, which may be related to its regulation on caspase-8.

Observation of Double Impurity Critical Gradients for Electromagnetic Turbulence Excitation in Tokamak Plasmas

The impact of impurity ions on a pedestal has been investigated in the HL-2A Tokamak, at the Southwestern Institute of Physics, Chengdu, China. Experimental results have clearly shown that during the H-mode phase, an electromagnetic turbulence was excited in the edge plasma region, where the impurity ions exhibited a peaked profile. It has been found that double impurity critical gradients are responsible for triggering the turbulence. Strong stiffness of the impurity profile has been observed during cyclic transitions between the I-phase and H-mode regime. The results suggest that the underlying physics of the self-regulated edge impurity profile offers the possibility for an active control of the pedestal dynamics via pedestal turbulence.

Inversion of infrared imaging bolometer based on one-dimensional and three-dimensional modeling in HL-2A

Linear regularization has been applied to the HL-2A infrared imaging bolometer to reconstruct local plasma emission with one-dimensional (1D) and three-dimensional (3D) modeling under the assumption of toroidal symmetry. In the 3D modeling, a new method to calculate the detector point response function is introduced. This method can be adapted to an arbitrarily shaped pinhole. With the full 3D treatment of the detector geometry, up to 50% of the mean-squared error is reduced compared with the 1D modeling. This is attributed to the effects of finite detector size being taken into account in the 3D modeling. Meanwhile, the number of the bolometer pixels has been optimized to 20 × 20 by making a trade-off between the number of bolometer pixels and the sensitivity of the system. The plasma radiated power density distributions have been calculated as a demonstration using 1D modeling and 3D modeling, respectively.

Development of frequency modulated continuous wave reflectometer for electron density profile measurement on the HL-2A tokamak

The frequency modulated continuous wave reflectometer was developed for the first time on the HL-2A tokamak. The system utilizes a voltage controlled oscillator and an active multiplier for broadband coverage and detects as heterodyne mode. Three reflectometers have been installed and operated in extraordinary mode polarization on HL-2A to measure density profiles at low field side, covering the Q-band (33-50 GHz), V-band (50-75 GHz), and W-band (75-110 GHz). For density profile reconstruction from the phase shift of the probing wave, a corrected phase unwrapping method is introduced in this article. The effectiveness of the method is demonstrated. The density profile behavior of a fast plasma event is presented and it demonstrates the capability of the reflectometer. These diagnostics will be contributed to the routine density profile measurements and the plasma physics study on HL-2A.

Development of electron cyclotron emission imaging system on the HL-2A tokamak

A 2D electron cyclotron emission imaging (ECEI) system has been developed for measurement of electron temperature fluctuations in the HL-2A tokamak. It is comprised of a front-end 24 channel heterodyne imaging array with a tunable RF range spanning 75-110 GHz, and a set of back-end ECEI electronics that together generate 24 × 8 = 192 channel images of the 2nd harmonic X-mode electron cyclotron emission from the HL-2A plasma. The simulated performance of the local oscillator (LO) optics and radio frequency (RF) optics is presented, together with the laboratory characterization results. The Gaussian beams from the LO optics are observed to properly cover the entire detector array. The ECE signals from the plasma are mixed with the LO signal in the array box, then delivered to the electronics system by low-loss microwave cables, and finally to the digitizers. The ECEI system can achieve temporal resolutions of ~μs, and spatial resolutions of 1 cm (radially) and 2 cm (poloidally).

Diamagnetic measurements by concentric loops in the HL-2A tokamak

The diamagnetic concentric loop method in the HL-2A tokamak is described in this article. The system consists of two concentric poloidal loops with different areas enclosing the plasma column and a short time constant differential integrator, RC < 1 ms. The diamagnetic flux in HL-2A ranges from 1 mWb to 2 mWb for typical discharges with plasma current Ip = 100-400 kA. The integrator output ranges from 0.1 V to 0.2 V with time constant RC = 0.5 ms, and differential area ΔS∕Sout ≈ 7%. Using hybrid analog-digital compensation, the integration drift can be well compensated within 5 mV∕10 s, which can meet the requirement of the concentric loop system. In this method, the measurement of differential area ΔS is not required. The vacuum toroidal flux can be compensated by adjusting the resistance in the integration circuit for several discharges with toroidal field only, which minimizes the additional error produced by a measurement of differential area. The diamagnetic concentric loop system improved the signal to noise ratio by using the short time constant integration. The system with a resolution of ±0.2 kJ can be used to study rapid changes in plasma stored energy, such as the additional power absorbed by the plasma, and the energy loss caused by edge localized modes.

Time-frequency analysis for microwave reflectometry data processing in the HL-2A tokamak

The Choi-Williams distribution (CWD) technique is introduced as a time-frequency tool for processing data measured from the new developed homodyne and the fixed frequency reflectometry in the HL-2A tokamak. The comparison between spectrogram and CWD for the simulated signal is presented. It indicates that the CWD can greatly improve the representation of the time-frequency content of the multi-components signal. Its effectiveness is demonstrated through two applications in HL-2A, which are the extraction of beat frequencies from the frequency modulated-continuous wave reflectometry (FM-CW) and the characterizing of the fluctuations. The density profile inversed from the group delay of the FM-CW and the density fluctuations deduced from the fixed-frequency reflectometry would be more reliable and accurate by using the CWD technique.

[TRUS-guided transperineal biopsy with 9 + X method for the diagnosis of prostate carcinoma: retrospective analysis of 420 cases]

OBJECTIVE

To explore the clinical value and safety of TRUS-guided transperineal biopsy with the 9 + X method in the diagnosis of prostate carcinoma.

METHODS

A total of 420 men underwent TRUS-guided transperineal biopsy with the 9 + X method for suspected prostate carcinoma. Their clinical data were retrospectively analyzed.

RESULTS

Prostate carcinoma was detected in 160 (38.1%) of the 420 cases, accounting for 7.4%, 17.8% and 65.4% in those with PSA < 4.0 microg/L, 4 -10 microg/L and > 10 microg/L respectively, 25.0% in those with abnormal findings on digital rectal examination (DRE), and 22.2% in those with abnormal echoes on TRUS or abdominal ultrasound examination. Complications after prostatic biopsy included gross hematuria in 79 cases (18.8%), acute urinary retention in 13 (3.1%) and fever in 9 (2.1%), but no other serious complications were observed.

CONCLUSION

TRUS-guided transperineal biopsy with the 9 + X method, with high accuracy and fewer complications, is an ideal approach to the diagnosis of prostate carcinoma.

[Diagnosis and treatment of primary epididymal tumor: a report of 35 cases]

OBJECTIVE

To explore the diagnosis and treatment of primary epididymal tumor.

METHODS

We retrospectively analyzed the clinical data of 35 cases of pathologically confirmed primary epididymal tumor. Of the total number of patients, 10 underwent tumor excision, 23 received epididymectomy, 1 was treated by simple orchidoepididymectomy, and by radical orchidoepididymectomy with second-stage retroperitoneal lymph node dissection.

RESULTS

Postoperative pathology confirmed 33 cases of benign tumor (including 21 adenomatoid tumor, 7 leiomyoma, 4 fibroma, and 1 papillary cystadenoma), and 2 cases of malignancy (1 malignant fibrous histiocytoma and 1 adenocarcinoma). The follow-up lasted 10 months to 6 years, which revealed no recurrence, metastasis and death.

CONCLUSION

Primary epididymal tumor is difficult to be definitely diagnosed preoperatively. Surgical exploration is the first choice for those highly suspected of the disease. Tumor excision or epididymectomy can be considered for benign cases, while radical orchidoepididymectomy with retroperitoneal lymph node dissection is recommended in case of malignancy.

Bio-distribution and anti-tumor efficacy of PEG/PLA nano particles loaded doxorubicin

As a more effective in vivo drug delivery system, several methods loading anti-cancer drugs to biodegradable and biocompatible nano-particles have been explored and developed. Supposedly due to the enhanced permeability and retention (EPR) effect, systemic administration of these nano-particles have been found to result in accumulation of nano-particles into solid tumors. In this study, we prepared nano-particles using polyethylene glycol (PEG)/poly-L-lactide (PLLA) diblock copolymer and loaded doxorubicin into these nano-particles (Nano-dox). The fabricated nano-particles exhibited sustained release kinetics of the drug in vitro. To follow the in vivo biodistribution of 200-350 nm sized nano-dox particles in tumor (syngenic renal cell adenocarcinoma: RENCA) bearing mouse, the carboxylfluorescenin diacetate succinimidyl ester (CFSE) was loaded into the nano-particles. Nano-dox accumulated preferentially in tumors; however, in terms of its anti-tumor efficacy, it did not show any marked benefits, compared to freely-administered doxorubicin. This result suggests the need to re-consider and evaluate what type of anti-cancer reagents we to be used in the ongoing efforts of coupling drug delivery system with tumor EPR effects.

[Efficacy and safety in chronic hepatitis B adolescent patients with lamivudine therapy]

OBJECTIVE

To analysis the efficacy and safety of lamivudine (made in China) therapy for 52 weeks in adolescent patients with chronic hepatitis B (CHB).

METHODS

One hundred and five teenage CHB patients were treated with lamivudine 100 mg once daily for 52 weeks. Patients with elevated ALT at baseline were in group 1 and those with normal ALT were in group 2. The changes of HBV DNA, HBV seromarkers and ALT at the end of 12, 24 and 52 weeks after lamivudine therapy were compared with those at baseline. Adverse events were recorded and evaluated.

RESULTS

At the end of 52 weeks of lamivudine therapy, HBV DNA-ve, HBeAg loss and anti-HBe seroconversion were observed in 92.0%, 24.4% and 22.0% in group 1 patients and 76.1%, 14.2% and 14.2% in group 2 patients respectively. No significant differences were found between two groups. At 12, 24 and 52 weeks, normalization rates of ALT were 59.0%, 66.7% and 76.0%, normal ALT with undetectable HBV DNA were 44.9%, 64.1% and 70.7% at the same time. During 52 weeks lamivudine treatment 26 mild adverse events were observed in 18 patients.

CONCLUSION

Lamivudine can inhibit HBV replication rapidly and normalize ALT in majority adolescent CHB patients. HBeAg loss or seroconversion of anti-HBe was observed in some of these patients. All patients in this study were safety and well tolerated.

A 3-year clinical trial of lamivudine in treatment of patients with chronic hepatitis B

BACKGROUND

Lamivudine was approved for the treatment of chronic hepatitis B in China in 1999; however the long-term result has not yet been reported in detail. This clinical trial was to evaluate the long-term efficacy and safety of 3-year lamivudine treatment for chronic hepatitis B and the impact of emergence of YMDD mutation of hepatitis B virus (HBV).

METHODS

This multi-center, randomized, double-blind, placebo controlled trial began from 1996 to 1999. A total of 429 patients with serum HBsAg, HBeAg and HBV DNA positive were randomized to receive either lamivudine 100 mg daily (322 patients) or placebo (107) for the first 12 weeks. All patients were given subsequently open labelled lamivudine 100 mg/d for a total of 156 weeks.

RESULTS

After 12-week lamivudine therapy, the levels of serum HBV DNA decreased rapidly. The negativity of HBV DNA (<1.6 pg/ml) at week 12 was 92.2% in the lamivudine group, whereas it was only 14.1% in the placebo group (P<0.01). After 1-year lamivudine treatment, 72.7% of the patients showed undetectable serum HBV DNA (<1.6 pg/ml). At the end of 3 years, serum HBV DNA continued to be substantially suppressed with a median level below a detectable level in patients with non-YMDD variant HBV, which was increased to 86 mEq/ml (bDNA method, equivalent hybridization method 10 pg/ml) in patients with YMDD mutation. At the end of 1, 2 and 3 years, the rates of HBeAg loss were 9.5%, 16.8% and 20.0% respectively and the rates of HBeAg/anti-HBe seroconversion were 8.3%, 11.5% and 17.3%. The rates of HBeAg loss and seroconversion were correlated with the baseline level of ALT. In patients with a baseline level of alanine transaminase (ALT)>2 x upper limit of normal (ULN) and ALT >5xULN, the rates of HBeAg loss were 42.2% and 66.7%, and the rates of seroconversion were 34.4% and 61.1% respectively (P<0.01) at the end of year 3. The levels of ALT at year 3 remained normal in 58.8% of patients whose baseline level of ALT was elevated, and in 79.1% of patients whose level of ALT was normal before treatment. YMDD mutations occurred in 12.1%, 49.7% and 70.5% of patients respectively at year 1, 2 and 3. In patients with YMDD mutation, the levels of HBV DNA were increased slightly with mild to moderate elevation of ALT level. HBeAg loss and seroconversion were 20.0% and 15.1% in patients with YMDD mutation at the end of year 3, which were lower than those in non-variant patients (P<0.01). Adverse drug reactions or events varied generally from mild to moderate. In 2 patients serious adverse events (fatigue and abdominal distension) were related to medication. ALT flares (ALT>5xULN) occurred in 17 patients: 10 were YMDD mutants and 7 were non-mutants; all of them were relieved. No death occurred in the period of 3 years.

CONCLUSION

Sustained inhibition of HBV replication and clinical improvement could be obtained after 3-year lamivudine therapy of good tolerance and safety.

Long-term safety of lamivudine treatment in patients with chronic hepatitis B

BACKGROUND & AIMS

Data on the long-term safety of lamivudine are limited. The aim of this analysis was to determine the incidence of hepatitis flares, hepatic decompensation, and liver-disease-related (LDR) serious adverse events (SAE) during long-term lamivudine treatment.

METHODS

We reviewed data on 998 patients with HBeAg-positive compensated chronic hepatitis B who received lamivudine for up to 6 years (median, 4 years) and 200 patients who received placebo for 1 year.

RESULTS

Hepatitis flares occurred in 10% of the lamivudine-treated patients in year 1 and in 18%-21% in years 2-5. A temporal association between hepatitis flares and lamivudine-resistant mutations increased from 43% in year 1 to >80% in year 3. Ten hepatic decompensation events occurred in 8 (<1%) lamivudine-treated patients. Fifty-three (5%) lamivudine-treated patients experienced a total of 60 LDR SAEs. Four patients died, 2 from liver-related causes. The proportion of patients with a documented lamivudine-resistant mutation increased from 23% in year 1 to 65% in year 5. During each year of the study, patients with lamivudine-resistant mutations experienced significantly more hepatitis flares than patients without lamivudine-resistant mutations (P < 0.005). The occurrence of hepatic decompensation (0%-2%) and LDR SAEs (1%-10%) among patients with lamivudine resistance remained stable during the first 4 years with mutations and increased afterward to 6% (P = 0.03) and 20% (P = 0.009), respectively.

CONCLUSIONS

This study demonstrated that lamivudine treatment for up to 6 years has an excellent safety profile in patients with HBeAg-positive compensated liver disease, but patients with long-standing lamivudine-resistant mutations may experience worsening liver disease.

[Observation of cardiac function, hemorheology and lingual microcirculation of leukemic patients]

The cardiac function, hemorheology and the lingual microcirculation of the 62 leukemic patients were investigated. The results showed that their left cardiac function was markedly damaged, and the blood specific viscosity and hematocrit lowered, the time of RBC electrophoresis extended, the ESR and the K value of ESR equation was increased, which suggested the blood agglutination was enhanced. The lingual microcirculation obviously displayed reducing the number of papilla fungiformis, of intrapapillar plexus of microvessel as well as vessel loops, it also revealed the increasing of the abnormal form of microvessel and of the dilating vessel loops. The colour of the blood flow showed pink and dark red, the condition around vessel loops showed exudation and bleeding in several cases.

[Preoperative selective intraarterial chemotherapy combined with gastrectomy in the treatment of gastric carcinoma]

In this study, 19 cases of gastric carcinoma were treated by selective intraarterial chemotherapy before surgical resection. Pathological examination of the resected specimen found that the effective rate of this selective chemotherapy was 89%. The survival rate of 6 months, 1 year, 2 years, and 3 years was 100%, 90%, 87%, and 83%, respectively.

[The production of IL-2, IL-6 in relation to the functional development of NK cells in human fetal spleens]

The production of IL-2, IL-6 by fetal splenic mononuclear cells (FSMC) and relationship between them and the ontogenetic development of natural killer cell function were studied in human fetal spleens. As a results, before 20 weeks of gestation, both IL-2 and NK cell activities were not measured, but IL-6 was done. It was found that IL-2, IL-6 and NK cell activities were increased with the gestational age, and shown that there were linear positive correlation between the activities of three ones above (r > 0.86). Before the birth, the induced IL-2 activity was the same as adult levels (p > 0.05), although both IL-6 production and NK activity in fetal spleens were significantly lower than that in adults (p < 0.01). Lastly, the production of IL-2, IL-6 in relation to the functional development of NK cells during the embryonic development was discussed.

[Experimental and clinical research of dachengqi decoction in treating post-traumatic respiratory distress syndrome]

12 cases of post-traumatic RDS treated with Dachengqi Decoction were reported.

RESULTS

10 patients survived, which showed a bright prospect for the treatment of post-traumatic RDS. In the experimental study, model of RDS was set up in rabbits. The pressure of PaO2 was determined and the morphologic changes of their lung tissues was observed after the rabbits were perfused with Dachengqi Decoction. The results showed that their PaO2 were markedly increased and lung conditions greatly improved, which provided an experimental basis for RDS with Dachengqi Decoction. Among 12 cases; nine were moderate cases and three serious ones. During the course of treatment with Dachengqi Decoction, two patients died, covering only 16.6% of the total number of patients. This fact confirms the efficacy of Dachengqi Decoction in treating the post-traumatic RDS.