[Effects of hand continuous passive motion system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand]

Objective: To observe the effects of hand continuous passive motion (CPM) system combined with functional training and pressure gloves in treating early scar contracture after burn on the back of the hand. Methods: A retrospective cohort study was conducted in 43 patients who met the inclusion criteria and were admitted to the First Affiliated Hospital of Air Force Medical University from June 2017 to December 2019 with scar contracture after deep partial-thickness to full-thickness burn on the back of the hand. According to the treatment methods applied, 13 patients were enrolled into pressure glove alone group (9 males and 4 females, aged (31±6) years), 14 patients were enrolled into pressure glove+functional training group (11 males and 3 females, aged (30±5) years), and 16 patients were enrolled into pressure glove+functional training+CPM system group (10 males and 6 females, aged (29±5) years). All the patients in the three groups received skin grafting on the back of the hand. The corresponding rehabilitation treatment was started 6-8 days after wound healing, and the treatment lasted for 3 months. Before treatment and after 3 months of treatment, the total active motion range of the hand was measured to evaluate the motion range of the hand joint and the ratio of excellent and good was calculated; the Carroll upper limb function evaluation method was used to evaluate the upper limb function score, and the difference before and after treatment was calculated; the Vancouver Scar Scale was used to evaluate the scar score, and the difference before and after treatment was calculated. Data were statistically analyzed with chi-square test, Fisher's exact probability test, McNemar's exact probability test, one-way analysis of variance, Bonferroni correction, least significant difference test, Kruskal-Wallis test, and paired sample t test. Results: The ratio of excellent and good of the motion range of the hand joint of patients in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group were 2/13, 2/14, and 3/16 respectively before treatment, and 4/13, 6/14, and 14/16 respectively after 3 months of treatment. The ratio of excellent and good of the motion range of the hand joint of patients was significantly higher in pressure glove+functional training+CPM system group than in the other two groups after 3 months of treatment (P<0.05 or P<0.01). Compared with that before treatment, the ratio of excellent and good of the motion range of the hand joint of patients in pressure glove+functional training+CPM system group was significantly increased after 3 months of treatment (P<0.01). Before treatment, the upper limb function score and hand scar score of patients in the three groups were similar (F=0.598, 0.035, P>0.05). After 3 months of treatment, the upper limb function score of patients was significantly higher in pressure glove+functional training+CPM system group than in pressure glove alone group (P<0.05); the hand scar score of patients was significantly lower in pressure glove+functional training group and pressure glove+functional training+CPM system group than in pressure glove alone group (P<0.05 or P<0.01), and the hand scar score of patients was significantly lower in pressure glove+functional training+CPM system group than in pressure glove+functional training group (P<0.05). Compared with those before treatment, the upper limb function scores of patients were significantly increased (t=-5.295, -7.252, -15.342, P<0.01) and the hand scar scores of patients were significantly decreased (t=13.361, 16.982, 40.334, P<0.01) in pressure glove alone group, pressure glove+functional training group, and pressure glove+functional training+CPM system group after 3 months of treatment. The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training+CPM system group were significantly higher than those in pressure glove+functional training group and pressure glove alone group (P<0.05 or P<0.01). The differences in upper limb function score and hand scar score of patients before and after treatment in pressure glove+functional training group were significantly higher than those in pressure glove alone group (P<0.05). Conclusions: Hand CPM system combined with functional training and pressure gloves can significantly improve the motion range of hand joint in treating early scar contracture after burn on the back of the hand, with better restoration of hand function and improvement of hand scar. Its effect is better than routine rehabilitation treatment such as functional training, etc., which is worthy of clinical reference.

[Effect of iron deficiency level on oral iron absorption]

Objective: To study the effect of iron deficiency level for oral iron absorption in iron deficient patients. Methods: 37 non-pregnant female patients who were diagnosed with iron deficiency and 13 healthy females who completed their physical examination at the outpatient department of the Anemia Center of the Institute of Hematology & Blood Diseases Hospital from July 2018 to June 2020 were included. Hepcidin and C2-C0 of oral iron absorption test were analyzed in different iron deficiency and serum ferritin level. Results: The median of Hepcidin in IDA, ID/IDE and healthy control group were 4.9 (2.17-32.86) , 26.98 (11.02-49.71) and 69.89 (42.23-138.96) μg/L (P<0.001) , respectively. Hepcidin level of IDA group was lower than that of ID/IDE group (adjusted P=0.005) and healthy control (adjusted P<0.001) . Hepcidin level of ID/IDE group had no significant difference compared with healthy control (adjusted P=0.22) . The mean of C2-C0 in IDA, ID/IDE and healthy control group were (35.30±21.68) , (37.90±14.06) and (23.57±10.14) μmol/L (P=0.130) , respectively. Multilinear regression analysis showed C0, SF, sTFR and HGB were independent factors for Hepcidin in iron deficient patients, with an equation of Hepcidin=-31.842-0.642*C0+2.239*SF+1.778*sTFR+0.365*HGB-0.274*RET-HB. We didn't find independent factor of C2-C0. Conclusion: The degree of iron deficiency had an effect on oral iron absorption. Patients of ID/IDE group absorbed iron more slowly than patients of IDA group. Iron deficient patients with normal gastrointestinal function absorbed more iron by oral administration when they were in a more serious iron deficient stage. Hepcidin was a better parameter to distinguish iron absorption level among different iron deficient patients than C2-C0 of oral iron absorption test.

[Adsorption and Desorption Behaviors of Antibiotics on TWP and PVC Particles Before and After Aging]

In recent years, microplastics (MPs), a new type of pollutant, have been widely dispersed in aquatic ecosystems. Compared with typical MPs (PVC, PP, PE, and PS), tire wear particles (TWP) exhibit significant differences in composition, additives, and characteristics. In this study, the adsorption and desorption of organic pollutants were compared between the typical MPs and TWP. With TWP and polyvinyl chloride (PVC) particles as adsorbents, oxytetracycline (OTC) and sulfamethoxazole (SMZ) as adsorbates, the adsorption and desorption of organic pollutants by TWP and PVC particles before and after aging were studied. Correctly understanding the behavior of MPs in an aquatic environment is of great significance. The results indicated that during the UV aging process, both TWP and PVC exhibited cracks, pits, and bulges on the particle surface, increased specific surface areas, increased strength of oxygen-containing functional groups, and enhanced hydrophilicity. The adsorption modes of TWP and PVC before and after aging were in two stages:surface adsorption and liquid film diffusion. TWP has a better fit for the Freundlich model, belonging to multi-layer adsorption, while PVC has a better fit for the Langmuir model, belonging to monolayer adsorption. The carrier effect of TWP on antibiotics was better than that of PVC, with the adsorption capacity of OTC on virgin TWP and PVC reaching 5.14 mg·g^-1 and 1.38 mg·g^-1, respectively. Additionally, the adsorption capacity of OTC on the aged TWP and PVC reached 5.82 mg·g^-1 and 2.13 mg·g^-1, respectively, which was better than with the virgin samples. The desorption capacity of aged TWP and PVC for antibiotics was better than the virgin materials, while the desorption rate was lower. In the same desorption solution, the desorption effect of TWP on antibiotics before and after ageing was better than that of PVC. The desorption effect of TWP and PVC on antibiotics in a simulated intestinal fluid environment was significantly better than that in an ultra-pure water environment.

Molecular mechanisms of inhibitor bindings to A-FABP deciphered by using molecular dynamics simulations and calculations of MM-GBSA

Adipocyte fatty-acid binding protein (A-FABP) plays a central role in many aspects of metabolic diseases. It is an important target in drug design for treatment of FABP-related diseases. In this study, molecular dynamics (MD) simulations followed by calculations of molecular mechanics generalized Born surface area (MM-GBSA) and principal components analysis (PCA) were implemented to decipher molecular mechanism correlating with binding of inhibitors 57Q, 57P and L96 to A-FABP. The results show that van der Waals interactions are the leading factors to control associations of 57Q, 57P, and L96 with A-FABP, which reveals an energetic basis for designing of clinically available inhibitors towards A-FABP. The information from PCA and cross-correlation analysis rationally unveils that inhibitor bindings affect conformational changes of A-FABP and change relative movements between residues. Decomposition of binding affinity into contributions of individual residues not only detects hot spots of inhibitor/A-FABP binding but also shows that polar interactions of the positively charged residue Arg126 with three inhibitors provide a significant contribution for stabilization of the inhibitor/A-FABP bindings. Furthermore, the binding strength of L96 to residues Ser55, Phe57 and Lys58 are stronger than that of inhibitors 57Q and 57P to these residues.

[Expression of iron-regulating erythroid factors in different types of erythropoiesis disorders]

目的

研究Erythroferrone（ERFE）等铁代谢红系调节因子（iron-regulatory erythroid factor）在不同类型红系造血异常疾病中的表达情况。

方法

采用ELISA方法检测2016年1月至2019年11月共47例真性红细胞增多症（PV）、纯红细胞再生障碍（PRCA）、自身免疫性溶血性贫血（AIHA）和骨髓增生异常综合征（MDS）患者血浆ERFE、生长分化因子15（GDF15）、生长分化因子11（GDF11）和扭转原肠胚形成同系物（TWSG1）的表达，分析铁代谢调节因子与红系造血异常类型及旺盛程度（以骨髓有核红细胞比例反映）的适配性。

结果

血浆GDF15表达水平在PV、PRCA、AIHA、MDS各组依次为266.01（112.40,452.37）、110.63（81.41,220.42）、52.11（32.61,171.66）、276.53（132.16,525.70）ng/L，均显著高于正常对照组的37.45（19.65,57.72）ng/L（P值均<0.01）。不同类型红系造血异常患者血浆TWSG1表达水平与正常对照组比较差异均无统计学意义（P值均>0.05）。血浆GDF11表达水平仅在PV组患者中明显高于正常对照组[74.75（10.95,121.32）ng/L对36.90（3.38,98.34）ng/L，P<0.01]，而PRCA、AIHA、MDS 3组患者与正常对照组比较差异无统计学意义（P>0.05）。PV组血浆ERFE水平为129.63（47.02, 170.03）ng/L，AIHA组血浆ERFE水平最高为121.76（68.12,343.11）ng/L，二者均明显高于正常对照组的43.23（35.18,65.41）ng/L（P值均<0.01）；PRCA组、MDS组血浆ERFE水平分别为48.92（44.59，84.83）、40.47（26.97,72.87）ng/L，与正常对照组比较差异无统计学意义（P值均>0.05）。骨髓有核红细胞比例与ERFE（r＝0.458，P＝0.001）呈正相关，而与GDF15（r＝−0.163，P＝0.274）、GDF11（r＝0.120，P＝0.421）、TWSG1（r＝−0.166，P＝0.269）无明显相关性。

结论

铁代谢红系调节因子在不同红系造血异常疾病的表达谱不尽一致，ERFE与红系造血旺盛程度相关度最高。

[Fibrosis-driving cells in patients with primary myelofibrosis and myelodysplastic syndromes with myelofibrosis]

Objective: To compare fibrosis-driving cells in patients with primary myelofibrosis (PMF) and patients with myelodysplastic syndromes (MDS) with myelofibrosis (MF) (MDS-MF) . Methods: Bone marrow biopsy sections of patients with newly diagnosed PMF and MDS (10 each randomly selected for MF-0/1, MF-2, and MF-3) were stained with specific immunofluorescence antibodies to label Gli1, LeptinR, alpha smooth muscle actin (α-SMA) , CD45, and ProcollagenⅠ. Images captured by confocal microscopy were analyzed by Fiji-ImageJ to calculate the cell counts of Gli1(+), LeptinR(+) cells, and fibrosis-driving cells including α-SMA(+), α-SMA(+)/Gli1(+), α-SMA(+)/LeptinR(+), and ProcollagenⅠ(+)/CD45(+) cells. Results: Patients with PMF and MDS with MF-2/3 had higher LeptinR(+), α-SMA(+), α-SMA(+)/Gli1(+), and Procollagen Ⅰ(+)/CD45(+) cell counts compared with those with MF-0/1 (all P values<0.05) . However, patients with PMF with MF-2/3 presented with higher Gli1(+) and α-SMA(+)/LeptinR(+) cell counts than those with MF-0/1 (P=0.001 and 0.006) , whereas these cells were similar between patients with MDS with MF-0/1 and MF-2/3 (P=0.169 and 0.067) . In patients with MF-0/1, all fibrosis-driving cells did not differ between PMF and MDS (all P>0.05) . However, in patients with MF-2/3, Procollagen Ⅰ(+)/CD45(+) cell counts were higher in patients with PMF compared with those with MDS (P=0.007) , while other fibrosis-driving cell counts were similar between these two groups (all P>0.05) . MF grade and fibrosis-driving cell counts were not correlated with overall survival in patients with either PMF or MDS. Conclusion: α-SMA(+) cells in patients with PMF originated from both Gli1(+) and LeptinR(+) cells, whereas α-SMA(+) cells in patients with MDS-MF only originated from Gli1(+) cells; patients with PMF had higher ProcollagenⅠ(+)/CD45(+) cell counts than those with MDS-MF.

[Genetic characteristics and prognostic values of RAS mutations in patients with myelofibrosis]

目的

分析骨髓纤维化（MF）患者RAS基因突变的分子特征及其临床特点和预后意义。

方法

收集2011年12月至2019年12月在我中心有二代基因测序数据的226例MF患者临床资料，回顾性分析RAS基因突变特征、与临床和实验室参数之间的关系，及对总生存（OS）期的影响。

结果

226例原发性骨髓纤维化（PMF）及真性红细胞增多症（PV）或原发性血小板增多症（ET）后骨髓纤维化（post-PV/ET MF）患者中，共14例（6.2％）检出RAS基因突变：NRAS突变9例（4.0％），KRAS突变8例（3.5％），NRAS及KRAS突变并存3例（1.3％）。所有NRAS突变均发生在第12-13号密码子。RAS基因突变多为亚克隆突变，常与SETBP1、SRSF2、MPL共同发生。伴RAS基因异常患者平均突变基因个数（3.36个）与无RAS基因异常组（1.77个）相比，差异有统计学意义（P<0.001）。RAS基因突变患者与无突变患者相比，外周血单核细胞水平升高（P＝0.003），血小板水平减低（P＝0.026），骨髓原始细胞比例升高（P＝0.022），脾脏肋缘下≥10 cm患者比例更高（P＝0.005）。突变组患者非常高危（VHR）染色体核型比例（18.2％，2/11）显著高于无突变组患者（2.3％，3/133）（P＝0.031）。单因素分析中，NRAS基因突变的MF患者及PMF患者的OS时间较无突变患者显著缩短（P＝0.001，P＝0.008）。多因素分析显示，NRAS突变是影响OS的独立预后不良因素。

结论

RAS突变常与外周血单核细胞水平升高、血小板计数减低、骨髓原始细胞比例升高、VHR染色体核型等高危临床特征及实验室参数相关，多为发生在MF晚期的亚克隆突变。伴NRAS基因突变PMF及MF患者的OS时间显著缩短。

[PTX3 promotes proliferation, invasion and drug resistance of neuroblastoma cells in children by regulating TLR4/NF-κB signaling pathway]

Objective: To investigate the effect of pentraxin 3 (PTX3) on the proliferation, invasion and drug resistance of pediatric neuroblastoma cells and its mechanism. Methods: si-RNA (si-RNA group), si-PTX3 (si-PTX3 group), siRNA+ pcDNA3.1 (siRNA+ pcDNA3.1 group), si-PTX3+ pcDNA3.1 (si-PTX3+ pcDNA3.1 group), siRNA+ pcDNA3.1-Toll-like receptor 4 (siRNA+ pcDNA3.1-TLR4 group) and si-PTX3+ pcDNA3.1-TLR4 (si-PTX3+ pcDNA3.1-TLR4 group) were transfected into SH-SY5Y cells. Collected 32 cases of tumor tissue and cancerous tissue in children with childhood neuromaternal cells who were treated at Zhumadian center hospital from July 2016 to August 2019. Real-time fluorescent quantitative polymerase chain (RT-qPCR) reaction and immunohistochemistry experiments were used to detect the protein expressions of PTX3 in neuroblastoma tissues and normal tissues. 5-Ethynyl-2'-deoxyuridine (EdU) was used to detect the proliferation effect of PTX3 on neuroblastoma cell SH-SY5Y. Western blot experiment was used to detect the protein expression levels of vascular endothelial growth factor (VEGF), resistance-related proteins including P-glycoprotein (P-gp) and multidrug resistance-associated protein 1 (MRP-1), and invasion-related protein matrix metalloproteinase-1 (MMP-1). Results: PTX3 mRNA expressions in neuroblastoma tissues were 0.87±0.07, higher than 0.13±0.06 of normal tissues, and the differences were statistically significant (P<0.05), The expression of the immunohistochemistry test PTX3 protein was consistent with the qRT-PCR results. Compared with the si-RNA group (0.95±0.08; 1.02±0.10), the mRNA and protein expressions of PTX3 in the si-PTX3 group (0.25±0.05; 0.45±0.66) decreased, the differences were statistically significant (all P<0.05). The number of EdU positive cells, invasion rate, VEGF, MMP-1, P-gp and MRP-1 protein expressions in si-RNA group were (31.86±1.86)%, (28.12±2.96)%, (0.58±0.07), (0.44±0.06), (0.46±0.08) and (0.51±0.05), respectively, higher than (19.73±1.22)%, (8.45±1.06)%, (0.25±0.05), (0.19±0.03), (0.19±0.06) and (0.16±0.07) in si-PTX3 group, and the differences were statistically significant (all P<0.05). The Number of EdU positive cells [(19.49±1.68)%], invasion rate [(8.48±1.36)%], VEGF protein expression (0.10±0.15), P-gp (0.18±0.07) , TLR4 (0.45±0.06), p-p65 (0.25±0.05) protein expressions in si-PTX3+ pcDNA3.1 group were relatively lower compared with siRNA+ pcDNA3.1 group [(38.21±2.67)%, (26.39±2.14)%, 0.49±0.05, 0.52±0.06, 0.93±0.14 and 0.82±0.06] (all P<0.05). The number of EdU-positive cells [(62.73±5.18)%], invasion rate [(50.45±3.25)%], VEGF protein expression (2.17±0.17), P-gp (2.15±0.16), TLR4 (2.68±0.16), p-p65 (2.48±0.13) protein expressions in the siRNA+ pcDNA3.1-TLR4 group increased compared with siRNA+ pcDNA3.1 group (all P<0.05). Conclusions: Inhibition of PTX3 can inhibit the proliferation and invasion of neuroblastoma cells SH-SY5Y, and reduce drug resistance. Its mechanism may be achieved by regulating the TLR4/NF-κB signaling pathway. This result can provide a new perspective for pediatric neuroblasts tumor diagnosis and clinical treatment.

[Pathological characteristics of megakaryocytes in myeloproliferative neoplasms and their correlation with driver gene mutations]

Objective: To investigate the pathological characteristics of megakaryocytes in myeloproliferative neoplasms(MPN)and their correlations with driver gene mutations. Methods: Trephine specimens administered for 160 patients with MPN from February 2012 to October 2017 were reevaluated according to the World Health Organization(WHO)'s(2016)diagnostic criteria. Results: This cohort of patients included 72(45.0%)men, with the median age of 59(range, 13-87)years, comprising 39 with polycythemia vera(PV), 33 with essential thrombocythemia(ET), 37 with prefibrotic/early-primary myelofibrosis(pre-PMF), 37 with overt PMF, 1 with post-ET MF, 2 with post-PV MF, and 11 with MPN-unclassifiable(MPN-U)after the re-diagnosis. With PV, ET, pre-PMF, and overt PMF changes, proportions of dense clusters, hypolobulated nuclei, and naked nuclei of megakaryocytes gradually increased, whereas erythropoiesis gradually decreased. Proportions of reticulin, collagen, and osteosclerosis grades of ≥1 also increased. Dense clusters, hypolobulated nuclei, and naked nuclei of megakaryocytes were negatively correlated with erythropoiesis and positively correlated with granulopoiesis and fibrosis. In patients with pre- and overt PMF, dense clusters and naked nuclei of megakaryocytes were positively correlated with fibrosis. Patients with JAK2V617F MPN had significantly increased erythropoiesis(P=0.022). Patients with CALR-mutated MPN were characterized by increased loose and dense clusters; paratrabecular distribution and naked nuclei of megakaryocytes(P=0.055, P=0.002, P=0.018, P=0.008); and increased reticulin, collagen, and osteosclerosis(P=0.003, P<0.001, P=0.001). In patients with pre- and overt PMF, patients with JAK2V617F had increased cellularity(P=0.037). CALR-mutated patients had increased dense clusters and giant sizes of megakaryocytes, collagen, and osteosclerosis(P=0.055, P=0.059, P=0.011, P=0.046). Conclusion: Megakaryocytes showed abnormal MPN morphology and distribution, which were related to fibrosis. CALR mutation was probably associated with abnormal morphology and distribution of megakaryocytes and fibrosis.

Circular RNAs: Promising biomarkers for cancer diagnosis and prognosis

Circular RNAs (circRNAs), a group of non-coding RNA characterized by the presence of covalent bonds linking 3' and 5' ends, act as miRNA sponges to participate in the tumorigenesis. Being stable, conserved and cell- or tissue-specific, circRNAs have shown their potentials as molecular markers for cancer. Convenient and noninvasive approaches may be developed based on the roles of circRNAs to diagnose or predict the prognosis of tumors. Although most of the potential mechanisms are not entirely clear, circRNAs have shown a universal and critical role in regulating cellular processes of cancers. This review summarized the classification, formation, characteristics, detection, and biological functions of circRNAs. We proposed the possibility of using circRNAs as biomarkers for cancer diagnosis, treatment and prognosis.

Circular RNA in cancer development and immune regulation

Circular RNAs (circRNAs) are a class of single‐stranded RNAs with closed loop structures formed by covalent bonds of head and tail. Exploration of circRNAs is continually increasing; however, their functional relevance largely remains to be elucidated. In general, they are stable, abundant, conserved and expressed in tissue‐specific manner. These distinct properties and their diverse cellular actions indicate that circRNAs modulate transcription and translation, and may even function as translation templates. Growing evidence reveals that circRNAs contribute to various physiological and pathological processes, including the initiation and progression of cancer. In this review, we present the current knowledge about circRNAs in cancer development, as well as their potential for use as biomarkers and even therapeutic targets. CircRNA’s role in immune regulation and antitumour immunotherapy is also discussed. In addition, possible challenges in antitumour therapy are raised, and current progress and future perspectives are provided.

[One case successfully rescued acute poisoning caused by misadministration of large amount of glufosinate]

Objective: To report a case of acute glufosinate-ammonium poisoning cause respiratory cardiac arrest and grass amine poisoning cases of successful rescue. Methods: The clinical data of a case of acute glufosinate-ammonium poisoning admitted to a third-class a hospital in April 2018 were analyzed and summarized. Results: The patient was poisoned by oral administration of a large amount of glufosinate-ammonium. Respiratory and cardiac arrest occurred during treatment and resuscitation was successful Later, the nervous system showed impaired function, The patients were treated with complete gastrointestinal cleansing, hemoperfusion, and the protection of important organs. Conclusion: For a large number of patients with oral glufosinate-ammonium poisoning, we should pay close attention to the damage of nervous system while taking active and conventional detoxification treatment.

[Efficacy and safety of early initiation of sacubitril-valsartan therapy in patients with acute decompensated heart failure]

Objective: To assess the efficacy and safety of the initiation of sacubitril-valsartan （ARNI） therapy, as compared with ACEI therapy, after hemodynamic stabilization among patients hospitalized for acute decompensated heart failure （ADHF）. Methods: A total of 199 hospitalized patients for ADHF in our department from January 2017 to June 2019 were included in this retrospective analysis. According to the medication early after hemodynamic stabilization, patients were divided into ARNI group (n=92) and ACEI group (n=107). Among the included patients, 61 patients with newly diagnosed heart failure at the time of admission were also divided into ARNI group (n=30) and ACEI group (n=31) according to the applied medication. Clinical baseline data and follow-up results of enrolled patients were collected through the electronic medical records at admission, outpatient and telephone follow-up. The primary effectiveness observation index was left ventricular ejection fraction (LVEF) and left ventricular end diastolic dimension (LVEDD) measured by echocardiography; the secondary observation index was death from any causes and hospitalization for heart failure. Safety outcomes were the incidences of symptomatic hypotension, worsening renal function, hyperkalemia, and angioedema. Results: The clinical baseline characteristics were similar between ARNI group and ACEI group（all P>0.05）. The duration of follow up was (15.2±6.5) months in all patients enrolled, (12.3±5.0) months in ARNI group, and (18.2±6.5) months in ACEI group. At the end of follow-up, prevalence of an absolute LVEF increase of more than 5% was 48.9% (45/92) in ANRI group and 25.2% (27/107) in ACEI group (P=0.001). Percent of LVEF increase to more than 50% was 17.4% (16/92) in ANRI group and 3.7% (4/107) in ACEI group (P=0.001). Percent of patients with more than 10 mm LVEDD reduction was 14.1% (13/92) in ANRI group and 3.7% (4/107) in ACEI group (P=0.009). All-cause mortality rate was 5.7% (5/88) in ARNI group and 15.3% (13/85) in ACEI group (P=0.038). Rate of re-hospitalization due to heart failure was 50% (46/92) in ARNI group and 71% (76/107) in ACEI group（P=0.002）.The rates of symptomatic hypotension, worsening renal function, hyperkalemia, and angioedema were similar between ARNI group and ACEI group (all P>0.05). In patients with first diagnosed heart failure，percent of LVEF increase to more than 50% was 30% (9/30) in ANRI group and 6.5% (2/31) in ACEI group (P=0.017). Percent of more than 10 mm LVEDD reduction was 26.7%(8/30) in ANRI group and 3.2%(1/31) in ACEI group (P=0.012). Percent of an absolute LVEF increase of more than 5% was 53.3% (16/30) in ANRI group and 51.6% (16/31) in ACEI group (P=0.893). Re-hospitalization due to heart failure was 23.3% (7/30） in ARNI group and 73.3% (11/31) in ACEI group（P<0.01）. Rate of all-cause death tended to be lower in patients receiving ARNI (3.4% (1/29)) as compared to patients receiving ACEI (13.0% (3/23), P=0.197）. Conclusions: Among patients with heart failure with reduced ejection fraction hospitalized for ADHF, the initiation of ARNI therapy after hemodynamic stabilization is associated with a more significant improvement of cardiac remodeling and pump function than ACEI therapy and satisfactory safety. In ADHF patients with first diagnosed heart failure, initiation of ARNI therapy after hemodynamic stabilization can more effectively improve cardiac remodeling and pump function than treatment with ACEI.

[Expressions and effects of autophagy-related genes in bleomycin-induced skin fibrosis of mice]

Objective: To investigate the expressions and effects of autophagy-related genes in bleomycin-induced skin fibrosis of mice. Methods: (1) Totally 72 male BALB/c mice aged 6 weeks were divided into blank control group, simple phosphate buffer solution (PBS) group, and bleomycin group according to the random number table, with 24 mice in each group. Mice in blank control group received no treatment, and 100 μL of PBS and bleomycin (1 mg/mL) were respectively injected subcutaneously in the back skin of mice in simple PBS and bleomycin group, once a day for 28 days. On injection day (ID) 7, 14, 21, and 28, 6 mice in each group were collected to observe the skin change on the back of mice with naked eyes. After the observation, the mice were sacrificed and skin tissue on the back was taken. Skin tissue of mice on ID 28 was collected to measure the thickness of skin tissue by routine hematoxylin-eosin staining and observe skin tissue morphology by Masson staining. Skin tissue on ID 7, 14, 21, and 28 was taken to detect content of hydroxyproline by enzyme linked immunosorbent assay, and mRNA and protein expressions of p62, microtubule-associated protein 1 light chain 3 Ⅱ (LC3 Ⅱ) and Beclin-1 were detected by real-time fluorescent quantitative reverse transcription polymerase chain reaction and Western blotting, respectively. (2) Skin tissue of mice in blank control group in experiment (1) was taken to culture fibroblasts (Fbs) in 3rd-6th passages. The cells were divided into blank control group, simple PBS group, and bleomycin group according to the random number table, with 6 wells in each group. Cells in blank control group were not stimulated, and cells in simple PBS group and bleomycin group were stimulated with 20 μL of PBS and bleomycin (1 mg/mL) for 72 h, respectively. Cellular immunofluorescence staining was used to observe the expression of LC3 Ⅱ. Data were statistically analyzed with analysis of variance of factorial design, one-way analysis of variance, t test, and Bonferroni correction. Results: (1) Skin on the back of mice in blank control group and simple PBS group was thin and ruddy, and the veins were clear on ID 7, 14, 21, and 28. Several raised ridges were visible on the puncture site of mice in simple PBS group from ID 14. Skin on the back of mice was ruddy, with several raised ridges visible on the puncture site of mice in bleomycin group on ID 7, the skin turned slightly white on ID 14, the skin turned white obviously with unclear surrounding blood vessels on ID 21, and the skin turned white and the surrounding blood vessels could not be recognized on ID 28. (2) On ID 28, the skin thicknesses of mice in blank control group and simple PBS group were similar (t=0.79, P>0.05). Compared with that in blank control group and simple PBS group, the skin thickness of mice in bleomycin group was significantly increased (t=0.50, 0.50, P<0.01). (3) On ID 28, the skin tissue structure of mice in blank control group and simple PBS group was similar, with a small amount of orderly arranged collagen and evenly distributed hair follicle; the number of collagen of skin in mice of bleomycin group was increased obviously and arranged disorderly, and the number of hair follicle was decreased significantly. (4) On ID 7, 14, 21, and 28, the content of hydroxyproline in the skin tissue of mice in bleomycin group was significantly higher than that in blank control group and simple PBS group (t=0.99, 0.98, 0.50, 0.51, 0.50, 0.50, 0.52, 0.51, P<0.05 or P<0.01). (5) On ID 7, p62 mRNA expression in the skin tissue of mice in bleomycin group was significantly lower than that in simple PBS group (t=0.93, P<0.05). On ID 14 and 21, the mRNA expressions of p62, LC3 Ⅱ, and Beclin-1 in the skin tissue of mice in bleomycin group were significantly higher than those in blank control group (t=0.74, 0.70, 0.58, 0.49, 0.51, 0.74, P<0.05) and simple PBS group (t=0.94, 0.65, 0.65, 0.77, 0.49, 0.51, P<0.05). On ID 28, the mRNA expressions of p62 and Beclin-1 in the skin tissue of mice in bleomycin group were significantly lower than those in blank control group (t=0.50, 0.44, P<0.05) and simple PBS group (t=0.97, 0.55, P<0.05), and that of LC3 Ⅱ was significantly higher than that in blank control group and simple PBS group, respectively (t=0.51, 0.98, P <0.01). (6) On ID 7, 14, 21, and 28, the protein expressions of LC3 Ⅱ in blank control group, simple PBS group, and bleomycin group were 0.167±0.042, 0.122±0.016, 0.553±0.078, 0.118±0.035, 0.120±0.023, 0.117±0.061, 0.581±0.039, 0.159±0.065, 0.233±0.027, 0.304±0.031, 1.020±0.010, 0.089±0.045. On ID 14, the protein expressions of p62 and Beclin-1 in the skin tissue of mice in bleomycin group were significantly higher than those in blank control group (t=0.86, 0.89, P<0.05) and simple PBS group (t=0.42, 0.89, P<0.05). On ID 21, the protein expressions of p62, LC3 Ⅱ, and Beclin-1 in the skin tissue of mice in bleomycin group were significantly higher than those in blank control group and simple PBS group (t=0.82, 0.45, 0.50, 0.79, 0.51, 0.50, P<0.01). On ID 28, the protein expressions of p62, LC3 Ⅱ, and Beclin-1 in the skin tissue of mice in bleomycin group were significantly lower than those in blank control group and simple PBS group (t=0.77, 0.54, 0.52, 0.50, 0.51, 0.50, P<0.05). (7) After culture for 72 h, the expression of LC3 Ⅱ in Fbs of bleomycin group was significantly lower than that of blank control group and simple PBS group, respectively. Conclusions: In the process of bleomycin stimulating skin fibrosis, autophagy-related genes increase firstly and then decrease. When the autophagy process is activated, it is expected to reverse the process of skin fibrosis.

[Effect of silent information regulator 1 on the LPS induced lncRNA expression of macrophages in mice]

Objective: To investigate the effect of Silent information regulator 1 (Sirt1) on the expression profile of long non-coding RNA (lncRNA) in macrophages upon lipopolysaccharide (LPS) treatment. Methods: Peritoneal macrophages (PM) were isolated from nine wild-type C57BL/6 male mice (wild-type group) and nine myeloid-specific Sirt1 knock-out mice (knock-out group). RNA samples were extracted from macrophages stimulated with 1 μg/ml LPS. Sequencing and the differentially expressed lncRNA were screened after the RNA was quantified. The threshold set for up-and down-regulated genes was a fold change (wild-type group/knock-out group) ≥2 and P≤0.05. Afterwards, gene ontology (GO) and pathway enrichment analysis were conducted and co-expression network map was constructed. Results: Four hundred and forty five lncRNA genes were differentially expressed (185 lncRNA genes were up-regulated and 260 lncRNA genes were down-regulated). Two hundred mRNA genes were differentially expressed (113 mRNA genes were up-regulated and 87 mRNA genes were down-regulated). It was found that the differentially expressed lncRNA genes and the predicted corresponding target genes were mainly distributed in the regions of biological processes of macrophage inflammatory response, macrophage chemotaxis and cell metabolism by GO and pathway enrichment analysis. Conclusion: lncRNA expression profile changes significantly in LPS induced macrophages isolated from Sirt1 knock out mice, which is closely related to the function of macrophages.

[The anti-proliferative and anti-inflammatory mechanisms of JAK1 inhibitor SHR0302 versus Ruxolitinib in SET2 cell line and primary cells]

目的

探究选择性JAK1抑制剂SHR0302和芦可替尼对骨髓增殖性肿瘤（MPN）细胞株SET2细胞和MPN患者原代细胞的影响以及分子作用机制。

方法

CCK8法检测不同浓度SHR0302和芦可替尼对SET2细胞增殖能力的影响；集落形成实验检测SHR0302和芦可替尼对MPN患者原代细胞红系爆式集落形成单位（BFU-E）的作用；多因子检测试剂盒MSD检测SHR0302和芦可替尼对SET2细胞IL-6、TNF-α、IL-1β、IL-2、IL-8、IL-12p70蛋白表达水平的影响；以Western blot法检测SHR0302和芦可替尼对SET2细胞JAK-STAT信号通路分子磷酸化水平的影响。

结果

0.1、1.0、2.5、5.0 µmol/L SHR0302作用SET2细胞24、48、72 h，细胞增殖抑制率随药物浓度的增大而增高（P< 0.001）；0.01、0.05、0.10 µmol/L芦可替尼作用SET2细胞48、72 h，细胞增殖抑制率亦随药物浓度的增大而增高（P<0.001），且均在72 h抑制作用最显著。2.5 µmol/L SHR0302、0.1 µmol/L芦可替尼作用SET2细胞72 h，细胞增殖抑制率分别为（59.94±0.60）％、（64.00±0.66）％，提示SHR0302的增殖抑制作用弱于芦可替尼。与对照组比较，0.1、1.0、5.0 µmol/L SHR0302和0.1、0.2、0.4 µmol/L芦可替尼均浓度依赖性地抑制MPN患者BFU-E形成，1.0 µmol/L SHR0302对MPN患者BFU-E集落形成抑制程度与0.2 µmol/L芦可替尼相当。除IL-12外，1.6 µmol/L SHR0302作用SET2细胞24 h可明显抑制炎性介质蛋白IL-6、TNF-α、IL-1β、IL-2、IL-8表达（P<0.01），与1.0 µmol/L芦可替尼对炎性介质抑制作用相当。不同浓度SHR0302作用SET2细胞3 h后JAK-STAT信号通路显著抑制，在1.0 µmol/L时可显著抑制p-STAT1（Tyr701）、p-STAT3（Tyr705）蛋白磷酸化，在5.0 µmol/L时可使p-JAK1（Tyr1022/1023）、p-STAT5（Tyr694）蛋白磷酸化水平明显下调（P<0.05），而芦可替尼在0.1 µmol/L即可明显抑制下游STAT蛋白磷酸化水平。

结论

SHR0302能有效抑制MPN细胞株和患者原代细胞的增殖以及炎性因子表达，其机制可能与下调p-JAK1及其下游p-STAT1、p-STAT3、p-STAT5蛋白磷酸化水平相关，但其抗增殖、抗炎作用弱于芦可替尼。

[Application of adipose stem cells in tissue repair and reconstruction]

Adipose stem cells (ASCs) are mesenchymal stem cells derived from adipose tissue, and they have potentials of self-renewal and multi-directional differentiation. Compared with bone marrow mesenchymal stem cells, ASCs have many advantages, such as easy access, easy cultivation, and abundant content, which are valuable seed cells in the field of repair and reconstruction. In recent years, with the deepening of the researches on differentiation, regulation, and function of ASCs, the clinical application of ASCs has gradually increased with good therapeutic effects.

[Preliminary application value of ultrasound contrast agent with enteral nutritional suspension as mixed medium in locating indwelling nasointestinal tube in critically ill patients]

Objective: To evaluate the value of ultrasound contrast agent with enteral nutrition suspension as mixed medium in locating indwelling nasointestinal tube in critically ill patients. Methods: Total of 45 critically ill patients had nasointestinal tube indwelled were collected from June 1,2018 to April 1,2019 in the Intensive Care Unit of Zhejiang Provincial People's Hospital, including 30 males and 15 females, with an average age of (63±17) years.Enteral nutritional suspension Peptisorb Liquid was used as research medium,with the ultrasonic imaging performance of it confirmed by in vitro and in vivo experiments.The optimal mixing ratio of microbubble ultrasound contrast agent and Peptisorb Liquid was confirmed by in vitro experiment, then the mixture was quietly placed and its stability was dynamically observed. The nasointestinal tube was confirmed in the digestive tract by conventional ultrasound and then the ultrasound contrast mode turned on. Ultrasound contrast agent with Peptisorb Liquid as mixed medium was injected into the nasointestinal tube and the tube direction and end position were observed and recorded in real time. Abdominal X-ray examination or CT was used as the gold standard for verifying the location of the nasointestinal tube and the same result represented successful positioning. Results: The in vitro and in vivo experiments showed that Peptisorb Liquid had good ultrasound imaging uniformity and penetrating power, which could clearly show the range and boundary of the filling intestine cavity; the in vitro experiment showed that the ultrasound contrast agent prepared with the microbubble ultrasound contrast agent and Peptisorb Liquid by the ratio of 1∶1 000 and 1∶500 which had the best imaging effect and the best distribution uniformity, with the best stability within 10 minutes after quietly placed. Nasointestinal tubes were successfully located by using ultrasound contrast agent with enteral nutritional suspension as mixed medium in 95.6%(43/45) of the patients collected in this study,including success at one attempt in 39 cases, the operating time was (1.6±0.5) minutes and 4 cases were successfully located after multiple operations with (5.1±0.5) minutes, the tube bent in the stomach in one case and flexed back into the stomach from the descending duodenum in another. The operation failed in 2 cases (4.4%). No significant complications occurred during the examination. Conclusion: The ultrasound contrast agent with enteral nutritional suspension as mixed medium has the advantages of both, which can conveniently, safely and effectively locate the direction and end position of nasointestinal tube in critically ill patients.

[The application of Chinese version of anterior skull base questionnaire (ASBQ) in patients with anterior and middle skull base tumors]

Objective: To develop the Chinese version of anterior skull base questionnaire(ASBQ) and to verify its application in patients with anterior and middle skull base tumors. Methods: The following steps were finished including getting the permission from the author of the original English scale, translating and back-translating, tentative test, discussing the consequence and cultural debugging. From October 2016 to December 2018, 51 patients with skull base tumors from Xuanwu Hospital and China-Japan Friendship Hospital were enrolled as an experimental group, aged from 24 to 70 years old, with 19 males and 32 females, which included 27 patients with anterior skull base tumor and 24 patients with middle skull base tumor. From December 2016 to January 2018, 46 healthy volunteers were selected as a control group, aged from 18 to 36 years old, including 26 females and 20 males. The subjects in the test group and the control group were rigorously tested with official manuscripts and judged whether the manuscript was applicable. The SPSS 22.0 statistical software was used to analyze the data of the test group, the anterior skull base group, the middle skull base group and the control group to evaluate the performance of the scale. Results: Both the rate of the recovery and efficiency in experimental group, anterior skull base group and middle skull base group were 100%, with the average time of completion of (8.7±3.2), (11.2±4.0) and (7.3±2.1) min, respectively in each group. The r value of test-retest reliability was 0.96, 0.99 and 0.97 in experimental group, anterior skull base group and middle skull base group, with the split-half reliability coefficient of 0.91, 0.90 and 0.96, with the entire scale Cronbach's coefficient of 0.91, 0.95 and 0.93, respectively. The content validity and the construct validity of the scale were good enough, and the criteria validity was-0.483,-0.509 and -0.489 in experimental group, anterior skull base group and middle skull base group. The scale could well distinguish the difference of the quality of life between the preoperative and postoperative patients in experimental group and the middle skull base group. The difference of the quality of life in anterior skull base group was not found between preoperative and postoperative patients. Conclusion: The Chinese version of ASBQ has good reliability and validity, which is suitable for a wide range of Chinese patients with anterior and middle skull base tumors to assess their quality of life.

Down-regulated expression of Tim-3 promotes invasion and metastasis of colorectal cancer cells

To explore how Tim-3 is expressed and how its expression influences invasion and metastasis of colorectal cancer (CRC) cells. A total of 188 CRC patients were prospectively collected for this study. Meanwhile, 135 normal controls were incorporated during the same period. Intestinal samples of the CRC radical cancerous tissues, paracancerous tissues ( 5.0 cm beyond the cancer tissue) were collected for the following experiment. Furthermore, peripheral venous blood samples (10 ml) were collected from each subject. Immunohistochemical analysis, quantitative real-time polymerase chain reaction (RT-qPCR) and western blot were performed for the detection of Tim-3 in different tissues. The immunohistochemical staining results showed that a positive Tim-3 signal was localized in the cytoplasm and nucleus, observed as yellow or brown granules. Tim-3 was largely expressed in colon carcinoma tissues and normal colon mucosa tissues but was rarely expressed in the cell membrane. RT-qPCR results indicated that Tim-3 mRNA levels were significantly lower in CRC tissues than in paracancerous tissues and normal colon mucosa tissues. A trend of decreased Tim-3 mRNA levels was also found in the paracancerous tissues compared with the normal colon mucosa tissues (all P < 0.05). Western blot results revealed reduced Tim-3 protein expression in CRC tissues compared with normal colon mucosa tissues and paracancerous tissues, and Tim-3 protein expression was much lower in the paracancerous tissues than in the normal colon mucosa tissues (all P < 0.05). Furthermore, obviously lower Tim-3 mRNA levels were found in the poorly differentiated CRC patients and in those with lymph node metastasis and distant metastasis (all P < 0.05). Collectively, Tim-3 expression was mainly located in the cytoplasm and nucleus, showing down-regulated expression in colon carcinoma tissues compared with normal and paracancerous tissues. Reduced Tim-3 expression may promote CRC invasion and metastasis providing a medical reference for the treatment of CRC.

Enhanced magnetic circular dichroism by subradiant plasmonic mode in symmetric graphene oligomers at low static magnetic fields

Giant magnetic circular dichroism (MCD) that shows a different response to incident wave with left or right-handed circular polarization under external magnetic field is promising for magneto-optical sensing, revealing symmetry and degeneracy information of electronic states. However, traditional methods and materials that are used to obtain significant MCD involve highly strong external magnetic field. Based on the excitation of subradiant plasmonic mode and Fano resonance in graphene oligomers in the mid-infrared region, we numerically demonstrate that MCD is enhanced three times larger than the previously reported method, based on the resonance of electric dipole plasmonic mode. This giant MCD is attributed to the remarkably different excitation efficiency of subdradiant plasmonic mode due to the interparticle coupling under left or right-handed circular polarization incidence and external magnetic field. Our results offer an effective mechanism to enhance MCD signal at the nanoscale, which facilitates the sensing, spintronic, nanophotonics and other such fields.

[The impact of meisoindigo on apoptosis and proliferation of SET2 cell line by JAK-STAT pathway]

Objective: To observe the effect of meisoindigo on apoptosis and proliferation of JAK2/V617F heterozygous mutation cell line-SET2 cell line to further explore the role of JAK-STAT pathway in this effect. Methods: Cell apoptosis after treated with different concentration of meisoindigo (0, 5, and 10 μmol/L) was evaluated by flow cytometry at different time points (24, 48, 72 h). Cell proliferation with CCK8 test was evaluated at different time points (24, 48, 72, 96 h) after administered with different concentration of meisoindigo (0, 5, 10, and 20 μmol/L). After treatment with different concentration of meisoindigo (0, 5, 10, and 20 μmol/L), SET2 cells were collected after 12 h, and then cultured in incomplete methylcellulose-based medium for clone formation. JAK-STAT signaling pathway and apoptosis related protein by Western blot test were evaluated 12 h after administered with different concentration of meisoindigo (0, 5, 10, and 20 μmol/L). Results: At different time points after treated with meisoindigo, the apoptosis rate of SET2 cell lines increased (P<0.01) with the inhibited proliferation (P<0.01), and the decreased clone formation rate of SET2 cell lines [0 μmol/L meisoindigo: (4.48±1.19)%, 20 μmol/L meisoindigo: (2.55±0.36)%; Dunnett P=0.020] in the presence of augmented concentrations of meisoindigo. At 12 hours after administration with meisoindigo, the reduced expressions of JAK2, P-JAK2, P-STAT1, P-STAT3, P-STAT3, STAT5, the decreased anti-apoptosis proteins BCL-2, BCL-XL and the increased pro-apoptosis protein BID, BIM were observed in the presence of increased concentrations of meisoindigo. Conclusion: Meisoindigo played an important role during the apoptosis and the inhibition of proliferation in ph-negative myeloproliferative neoplasm cell-SET2 cell lines, which might be related to the inhibition of JAK-STAT signaling pathway with up-regulation of pro-apoptosis protein and down-regulation of anti-apoptosis protein.

Broadband reflective lens in visible band based on aluminum plasmonic metasurface

We demonstrate a flat optical lens based on plasmonic reflectarray metasurface, which consists of a planar array of hyperbolic-shaped aluminum (Al) nanoantenna separated from an Al ground plane by a SiO₂ spacer. The gradual change in the width of the Al nanoantenna enables unique broadband (400-700 nm) to focus on the visible band because of its hyperbolic reflection-phase profile. The focal length of metalens is quickly decreased with the increase of wavelength in the short wavelength region (400-550 nm), compensating the chromatic aberration in traditional lenses. In long wavelength region (550-700 nm), the focal length has only a slight change, thereby minimizing chromatic aberration. Furthermore, the proposed metalens creates a small focal spot beyond diffraction limit, while maintaining high focusing efficiency. Our method of simple and anisotropic nanoantenna is used to realize wide phase tuning range offers a novel strategy to design braodband metalens, and our metalens has widespread applications in compact camera, telescope, and microscope.

[Targeted sequencing analysis of hyper-eosinophilic syndrome and chronic eosinophilic leukemia]

Objective: Analysis of the molecular characteristics of eosinophilia. Methods: Targeting sequence to 24 patients with chronic eosinophilic leukemia (CEL) with rearrangement of PDGFRA, PDGFRB, or FGFR1 and 62 patients with hyper-eosinophilic syndrome (HES). Mutation annotation and analysis of amino acid mutation using authoritative databases to speculate on possible pathogenic mutation. Results: Thirty-seven kinds of clonal variant were detected from 17 patients with CEL, no recurrent mutation site and hot spot region were found. No pathogenic mutation was detected in 19 patients with PDGFRA rearrangement, but pathogenic mutations of ASXL1, RUNX1 and NRAS were detected from 2 patients with FGFR1 rearrangement who progressed to acute myeloid leukemia and 1 patient with PDGFRB rearrangement who progressed to T lymphoblastic lymphoma, respectively. One hundred and two kinds of clonal abnormalities were detected in 49 patients with HES. The main hot spot mutation regions included: CEBPA Exon1, TET2 Exon3, ASXL1 Exon12, IDH1 Y208C, and FGFR3 L164V. CRRLF2 P224L and PDGFRB R370C point mutations were detected separately in 2 patients with HES who treated with imatinib monotherapy and achieved hematologic remission. Conclusion: The pathogenesis of CEL with PDGFRA, PDGFRB or FGFR1 rearrangement is usually single, and the progression of the disease may involve other driver mutation. A variety of genes with hot mutation regions may be involved in the pathogenesis of HES, and some mutation sites are sensitive to tyrosine kinase inhibitors.