Mechanical factors and mechanism of keratoconus pathogenesis / 国际眼科杂志(Guoji Yanke Zazhi)

Keratoconus is a corneal ectatic disease characterized by progressive corneal thinning and protrusion. Its pathogenesis remains unclear. In vitro experiments have shown that mechanical stimulation may damage corneal stromal cells by increasing oxidative stress level and inflammatory factor concentration, resulting in a series of changes such as degradation of corneal extracellular matrix. Numerous clinical studies have confirmed that mechanical factors, including eye rubbing and eyeball compression caused by sleeping position, may play an important role in the process of keratoconus occurrence and development. They may affect the cornea by increasing the level of inflammatory factors in tear, causing changes in intraocular pressure, changing the biomechanical properties of the cornea, directly damaging corneal tissue by mechanical friction, and increasing the temperature of corneal epithelium. The main aim of this review was to describe the efforts of mechanical factors on corneal stromal cells, corneal tissue, and the possible role of mechanical factors in the pathogenesis of keratoconus, so as to provide a reference for the prevention and management of keratoconus.

Clinical features of coronavirus disease 2019 in children aged <18 years in Jiangxi, China: an analysis of 23 cases / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of coronavirus disease 2019 (COVID-19) in children aged <18 years.@*METHODS@#A retrospective analysis was performed from the medical data of 23 children, aged from 3 months to 17 years and 8 months, who were diagnosed with COVID-19 in Jiangxi, China from January 21 to February 29, 2020.@*RESULTS@#Of the 23 children with COVID-19, 17 had family aggregation. Three children (13%) had asymptomatic infection, 6 (26%) had mild type, and 14 (61%) had common type. Among these 23 children, 16 (70%) had fever, 11 (48%) had cough, 8 (35%) had fever and cough, and 8 (35%) had wet rales in the lungs. The period from disease onset or the first nucleic acid-positive detection of SARS-CoV-2 to the virus nucleic acid negative conversion was 6-24 days (median 12 days). Of the 23 children, 3 had a reduction in total leukocyte count, 2 had a reduction in lymphocytes, 2 had an increase in C-reactive protein, and 2 had an increase in D-dimer. Abnormal pulmonary CT findings were observed in 12 children, among whom 9 had patchy ground-glass opacities in both lungs. All 23 children received antiviral therapy and were recovered.@*CONCLUSIONS@#COVID-19 in children aged <18 years often occurs with family aggregation, with no specific clinical manifestation and laboratory examination results. Most of these children have mild symptoms and a good prognosis. Epidemiological history is of particular importance in the diagnosis of COVID-19 in children aged <18 years.

Cloning and expression analysis of iridoid synthase gene in Centranthera grandiflora / 中草药

Objective: To clone the CgIS gene encoding iridoid synthase from Centranthera grandiflora and conduct its expression analysis. Methods: Based on the sole sequence of CgIS gene in root, stem and leaf transcriptome of C. grandiflora, a CgIS gene was cloned from young leaves of C. grandiflora by RT-PCR technique, and its tissue-specific expressions were also performed. Results: The CgIS gene (GenBank accession number: MH794270) had a length of 1 185 bp coding for 394 amino acids, and the relative molecular weight of CgIS protein was 44 670 with its theoretical pI of 6.17. CgIS protein belonged to the member of P5βR (progesterone 5β-reductase) family, and might localize in cytoplasm. CgIS protein was a hydrophilic stable protein without signal peptide, and composed of mainly α-helix (40.61%) and coil (46.70%). The SDR (short-chain dehydrogenase/reductase) and P5βR conserved domains were existed in CgIS protein. CgIS protein was close to SiIS protein of Sesamum indicum. CgIS gene was primarily expressed in leaves. Conclusion: The CgIS gene is cloned, and its expressions are also analyzed, which will pave a way for further studies on function of CgIS gene and biosynthetic pathway of iridoids.

Chronic effects of 100 mg/2 hours recombinant tissue-type plasminogen activator therapy regimen for patients with acute pulmonary thromboembolism / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of 100 mg/2 hours recombinant tissue-type plasminogen activator (rt-PA) regimen for treating patients with acute pulmonary thromboembolism (PE) by observing long-term clinical outcome including recurrent pulmonary embolism, chronic thromboembolic pulmonary hypertension (CTEPH) and other complications.</p><p><b>METHODS</b>Data of 43 consecutive patients with acute high-risk and intermediate-risk PE treated with intravenous rt-PA (100 mg/2 hours) were prospectively analyzed. Median follow-up post-thrombolysis was (15.6 ± 11.4) months. The endpoints of the study were PE recurrence, death related to PE and onset CTEPH.</p><p><b>RESULTS</b>After rt-PA therapy, pulse pressure increased [(46.7 ± 9.5) mm Hg(1 mm Hg = 0.133 kPa)vs. (41.9 ± 11.3) mm Hg, P = 0.007], heart rate and respiratory rate decreased [(84.2 ± 14.7) bpm vs.(93.3 ± 17.7) bpm, P < 0.001; (20.2 ± 2.4) bpm vs. (23.2 ± 4.1) bpm, P < 0.001, respectively], tricuspid annular plane systolic excursion increased [(18.7 ± 3.1) mm vs. (15.9 ± 3.9) mm, P < 0.001] and right ventricle transverse diameter [(34.0 ± 3.6) mm vs. (36.8 ± 4.4) mm, P < 0.001]. PO2, SO2 and P(A-a)O2 improved [ (87.9 ± 17.8) mm Hg vs. (73.4 ± 20.1) mm Hg, P < 0.001; 96.6% ± 2.4% vs. 92.5% ± 6.3%, P < 0.001; 29.9 (12.3, 55.1) mm Hg vs. 52.1(31.5, 76.3) mm Hg, P = 0.014, respectively], D-dimer and NT-proBNP levels significant reduced (P < 0.001). Mortality rate related to PE was 6.9% (4/43) and there was no patient developed CTEPH during follow up.</p><p><b>CONCLUSION</b>The 100 mg/2 hours rt-PA regimen is effective to treat acute PE patients and could improve right heart function and outcome in patients with acute PE.</p>

Simultaneous determination of scopolamine hydrobromide, atropine sulfate, ephedrine hydrochloride and pseudoephedrine hydrochloride in Zhichuanling oral liquid with HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To establish an HPLC method for determining the contents of scopolamine hydrobromide, atropine sulfate, ephedrine hydrochloride and pseudoephedrine hydrochloride in Zhichuanling oral liquid.</p><p><b>METHOD</b>Agela Durashell RP-C18 (4. 6 mm x250 mm, 5 microm) was adopted, with acetonitrile-sodium phosphate buffer solution (0. 07 mol L-1 sodium phosphate solution with 17.5 mmol L-1 sodium dodecylsulfate adjusted to pH 6.0 with phosphoric acid solution) (30:70) as the mobile phase. The flow rate was 0. 9 mL min -1, the detection wavelength was 207 nm, and the column temperature was 25 degree C.</p><p><b>RESULT</b>Scopolamine hydrobromide, atropine sulfate, ephedrine hlvdrochloride and pseudoephedrine hydrochloride showed good linear relations with peak areas within the concentration range of 0. 021 21-1. 060 5 pg (r =0. 999 3) , 0. 011 14-0. 557 microg (r = 0. 999 6) , 0. 200 56-10. 028 microg (r =0. 999 7) and 0.070 33-3. 516 5 gg (r =0. 999 6), respectively, with the average recoveries of 101.9% , 99. 80%, 100. 3%, 100. 2% (n=6).</p><p><b>CONCLUSION</b>The method was so quick, simple, highly reproducible and specific that it could be used as one of quality control methods of Zhichuanling oral liquid.</p>

Effect of pretreatment with puerarin on activation of LPS-induced RAW264. 7 cells / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of pretreatment with puerarin on activation of LPS -induced RAW264. 7 cells and secretory cytokines, and discuss its anti-inflammatory mechanism.</p><p><b>METHOD</b>Well-grown RAW264. 7 cells in the exponential phase were collected and randomly divided them into the blank control group, the LPS group and the puerarin pretreatment + LPS group. The cellular toxic effect of puerarin on RAW264. 7 cells was examined by CCK-8 assay, cell morphology was detected by Giemsa stain method, the changes in TNF-alpha and MIP-2 were tested by ELISA, and the expression of NF-kappaB p65 mRNA were determined by qRT-PCR.</p><p><b>RESULTS</b>When puerarin was cultured with 1 mg x L(-1) LPS at a concentration of lower than 400 micromol x L(-1), it had not showed the cellular toxic effect (P < 0.05). Compared with the control group, the LPS group could significantly change the morphology of RAW264. 7 cells (increase in cell body, irregular shape, with a large number of pseudopodia extending). After intervention, the puerarin 100 micromol x L(-1) group could significantly inhibit LPS-induced cell morphological changes, while the puerarin 200 micromol x L(-1) and 400 micromol x L(-1) puerarin groups showed more notable inhibitory effects. However, there was no obvious difference between the two groups. The pretreatment with puerarin could inhibit the expression of TNF-alpha and MIP-2 in cell supernatant and NF-kappaB p65 mRNA in cells (P < 0.05). With increase in the puerarin concentration, its inhibitory effect gradually grew (P < 0.05), but did not reach the level of the blank control group.</p><p><b>CONCLUSION</b>As a safe and effective natural anti-inflammatory drug, puerarin can significantly reduce the expression of inflammatory cytokines (TNF-alpha, MIP-2). Its mechanism may be related to the reduction of NF-kappaB p65 mRNA expression.</p>

Evaluation of adrenocortical function in children with severe and critical enterovirus 71 infection / 中华儿科杂志

<p><b>OBJECTIVE</b>To evaluate the adrenocortical function in children with severe and critical enterovirus 71 infection by using a high-dose (250 µg) adrenocorticotropic hormone (ACTH) stimulation test. And to at provide experimental basis for glucocorticoid in the treatment of hand-foot-and-mouth disease (HFMD).</p><p><b>METHOD</b>This was a prospective multi-center study which was carried out in PICUs of Beijing Children's Hospital, Zhengzhou Children's Hospital, Kaifeng Children's Hospital and Linyi People's Hospital in Shandong province. Children with severe and critical hand-foot-mouth disease admitted to PICUs of the four hospitals from June 2009 to April 2010 were enrolled in this study, and EV71 virus nucleic acid test and high-dose (250 µg) ACTH stimulation started at the same time. EV71 virus nucleic acid positive 51 cases were eventually enrolled in the study. Cortisol test was performed at baseline (T0) and after high-dose (250 µg) ACTH stimulation at 30 minutes (T30), 60 minutes (T60) in the first 6 hours after admission, but before glucocorticoid was given. The adrenocortical function was evaluated according to ΔTmax [ΔTmax=(T30, T60 maximum)-T0]. Diagnostic criteria of adrenal insufficiency (AI) is increment (ΔTmax)≤9 µg/dl.</p><p><b>RESULT</b>The incidence of AI in 51 cases was 52.94% (27/51). The incidence of AI in severe group was 44.74% (17/38), which was significantly higher in critical group 76.92% (10/13), P<0.05. Of the cases with a pediatric critical illness score (PCIS)≤70, 81.82% (9/11) had adrenal insufficiency, and it was 28.57% (4/14) when PCIS≥90. The incidence of AI was 75% (6/8) and 48.84% (21/43) in death and survivor group respectively, but there were no significant difference between the two groups (P>0.05). Baseline (T0) cortisol in death group was higher than survivor group (P<0.05).</p><p><b>CONCLUSION</b>AI may occur in children with enterovirus 71 infection. The critical enterovirus 71 infection had a high incidence of AI. AI may affect the prognosis of patients with severe and critical enterovirus 71 infection. Exogenous glucocorticoids administration may be considered when AI is identified or highly suspected. The timing, dosage and regimen of glucocorticoid are still unclear. Further animal experiments and clinical trials are needed.</p>

Anatomic study of supratrochlear artery and its application in nasal reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the anatomy of the cutaneous branch (CB) of supratrochlear artery and its relevance to the design of frontal flap in nasal reconstruction.</p><p><b>METHODS</b>10 fresh cadavers were dissected to study the position and course of the CB of supratrochlear artery (supraorbital rim and facial midline as landmark). The communication between the CB and supraorbital artery was also studied. 5 cases of ultra-thin frontal flaps and 11 cases of bi-flap( cutaneous flap and muscular flap) were designed on anatomic basis. The survival rate of flap, the stability and aesthetic appearance of the reconstructed nose were followed up.</p><p><b>RESULTS</b>The supratrochlear artery gave off constant CB (1.18 +/- 0.36) cm from upper orbital rim and (1.35 +/- 0.34) cm from the midline of face. The CB passed in a subcutaneous plane and communicated with the bilateral muscular branch, CB of the opposite side and bilateral supraorbital artery. The supratrochlear artery only had CB with no muscular branch in 3 cases. All the flaps survived completely except one with blister on the nose tip which healed spontaneously. The postoperative aesthetic appearance was very satisfactory.</p><p><b>CONCLUSIONS</b>The supratrochlear artery has constant CB. The frontal ultra-thin flap pedicled with the CB can improve the therapeutic effect of nasal reconstruction.</p>

Repair of nasal lining in nasal reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To present a variety of techniques for providing nasal lining and discuss the application of these methods to specific nasal defects.</p><p><b>METHODS</b>Regard of the nasal defect's location, size, or depth of involvement, the approaches were used with turnover nasal skin or scar flaps (n=17), the buccal mucosal flap (n=1), the nasolabial flaps (n=5), prefabricated flaps (n=1) for lining. A formal nasal reconstruction was then carried out with use of rib cartilage grafts for support and a forehead flap for cover.</p><p><b>RESULTS</b>Necrosis of forehead flaps and lining tissues did not occur. 24 Cases have been followed for a 6-34 months period. Except some turnover scar flaps obstructed the airway and needed aggressive secondary surgical thinning, the other lining flaps remained stable from adequate restoration of form and function.</p><p><b>CONCLUSIONS</b>It is important to evaluate the exact sizes, volumes and layers missing of the nasal defects before rebuilding the lining defect. Choosing the adequate operation can provide good aesthetic and functional results. The prefabricated flap is good to be used to reconstruct nasal lining in complicated cases.</p>

Research of the preservation of the composite facial allograft / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effective method of preserving composite facial allograft so as to attenuate ischemic injury.</p><p><b>METHODS</b>The composite facial allografts were harvested from dog, perfused and preserved with 4 degrees C physiological sodium chloride and UW solution respectively. Immediately after the removal of the flap, after 12, 24, 48 h of preservation, MTT assay was used to determine the viability of several kinds of tissue, including skin, mucosa, muscle, bleed vessel, nerve and gland. The results of the two groups were compared in term of viability percentage. The pathology of several tissues were observed after 24 and 48 h of storage.</p><p><b>RESULTS</b>The viability percentage of every tissue conserved in UW solution for 48 hours was more than 75%. There was significant difference between physiological sodium chloride group and UW group (P < 0.05). Some changes, including Porous arrangement of fibers in connective tissue of skin and mucosa, hyalinization of tissue around the hair follicle and edema of cell in hair follicle, enlargement of space between muscle bundles and unclearness of boundary of acinus could be seen in physiological sodium chloride group while no significant change in UW group.</p><p><b>CONCLUSIONS</b>UW solution could be considered as preservation solution for composite facial allograft.</p>

Strategy study of harvesting total facial flap and donor choice for allograft transplantation in cadaver / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the operational strategy of harvesting total facial allograft by autopsy.</p><p><b>METHODS</b>Twelve fresh human cadavers were dissected. They were divided into two groups randomly. The total facial-scalp flap of the group I was elevated by the bi-pedicle method, the group II was operated with single-pedicle method. Both were dissected at the deep plane of the SMAS. : the time of facial flap harvesting, length of the artery vein and nerve pedicles of the donor were measured and marked, after operation, in each group we transferred one facial allograft to another. Then the free graft of group I was poured through artery by methylthioninium chloride to study vascular territories.</p><p><b>RESULTS</b>Mean harvesting time of the group I (46 +/- 11) minutes, group II (111 +/- 7) minutes, P < 0.01. Perfusion result shows that unilateral superficial temporal artery and the opposite side of the facial artery can supply blood for whole face. The pedicle was long enough for anastomosis. Post-operation appearance: the face looks like neither the donor nor the recipient primarily, It's mainly due to the characteristics of the skeleton and the soft tissues.</p><p><b>CONCLUSIONS</b>The bi-pedicle method of the harvesting total facial allograft is concise, fast, safe can be widely applied in clinical.</p>

Establishment of composite facial and scalp allograft transplantation model in canine / 中华整形外科杂志

<p><b>OBJECTIVE</b>To develop an experimental model of composite facial and scalp allograft in canine in order to investigate technical and immunological aspects and functional recovery of facial muscles of this new approach to facial reconstruction.</p><p><b>METHODS</b>(1) Anatomic study: Four mongrel dogs were used for anatomical dissection of the head and neck region and for harvesting flap experiment. (2) Autologous transplantation (group I): Three types composite facial and scalp autologous transplantation were performed in five mongrel dogs. Type I composite tissue flap (group I a n = 2) included bilateral external ear and orbicularis oculi muscle. Type II (group I b n = 1) included single-lateral external ear, orbicularis oculi muscle, external nose upper and lower lip. Type III (group I c n = 2) included single - lateral external ear and orbicularis oculi muscle. (3) Allograft transplantation (group II): In group II a (n = 2), two allograft transplantation were performed with type III composite facial and scalp . In group II b (n = 4), four allograft transplantation were performed with the modified type III composite facial and scalp which included single - lateral external ear, orbicularis oculi muscle and one third of inferior tarsal plate and palpebral conjunctiva. To prevent allograft rejection, Cyclosporin A (CsA) and Methylprednisolone (MP) or Prednisone (PS ) were combined used as immunosuppressive protocol . Dose of CsA was adjusted depending on its blood drug level. Electromyogram (EMG) of orbicularis oculi muscle was carried out at 4 weeks, 6 weeks, 12 weeks and 6 months postoperation.</p><p><b>RESULTS</b>(1) The facial anatomic characteristic of dog is similar to that of human being, external carotid artery and external jugular vein afford good blood supply to composite facial and scalp. (2) The dogs in group I c were long-term surviving with leakage of salivary juice. (3) In group II a (n = 2), one dog presented rejection reaction at 28th day postoperation, the reversal of rejection was achieved by increasing the dose of CsA and prednisone and with topical clobetasol for 2 weeks, the dog survived indefinitely( > 309 days). In group II b (n = 4), there were three dogs survived indefinitely ( > 159 days, > 129 days, > 108 days) without complication, EMG showed the function of orbicularis oculi muscle was gradually improving.</p><p><b>CONCLUSION</b>The modified type III composite facial and scalp allograft transplantation model is an ideal model for facial allograft transplantation study.</p>

Clinical study on three different operation procedure for hysterectomy / 中国基层医药

Objective To investigate the effects of three procedures for hysterectomy.Methods The clinical characteristics of 370 cases who respectively received hysterectomy by total transabdominal hysterectomy(TAH,150 cases),transvaginal hysterectomy(TVH,120 cases),or laparoscopically assisted vaginal hysterectomy(LAVH,100 cases)were analyzed and their effects and outcomes and the expenses for medical treatment were compared from 2000 January to 2005 December.Results The average operation time of TAH,TVH and LAVH was(78?28) minutes,(102?35)minutes,(119?28)minutes respectively.The average operation time of TAH was significantly shorter than that of TVH and LAVH groups(P＜0.01).The volume of hemorrhage during operation in TAH group was less than that of other two groups significantly[TAH(53?29)ml,TVH(110?35)ml,LAVH(93?50 )ml](P＜0.01).The average time of bowel function recovery in TAH group[(42?7)hours]was significantly longer than that of TVH[(23?5)hours]or LAVH[(25?4) hours]groups(P＜0.01).The average hospital stay after opera- tion in TAH[(8.9?1.1)days]group was significantly longer than that of TVH[(5.7?2.4)days]or LAVH [(6.3?1.9)days] groups(P＜0.01).The average expenses for medical treatment in LAVH[(7273?938)yuans] group was significantly more than that of TAH[(5594?308)yuans]or TVH[(5450?167)yuans]groups(P＜0.01).But the lesion and the complication after operation of three groups had no difference.Conclusion Different procedures for total hysterectomy have their own advantage and disadvantage.The operation procedure must take ac- count of the economy,echnique of medical treatment and the condition of the hospital.