Consistency and Repeatability of Cerebral Blood Flow by Automatic Segmentation of Region of Interest and 3D-pCASL Fusion in Hippocampal Subregions / 中国医学影像学杂志

Purpose To evaluate the consistency and repeatability of cerebral blood flow(CBF)values measured by automatic segmentation of region of interest(ROI)and arterial spin labeling(ASL)functional image fusion in hippocampal sclerosis patients with medial temporal lobe epilepsy.Materials and Methods From January 2021 to October 2022,a total of 52 patients with medial temporal lobe epilepsy confirmed by MRI or pathology in General Hospital of Ningxia Medical University were retrospectively collected.All subjects were scanned on 3.0T MRI to obtain axial T1 weighted three-dimensional magnetization reserve gradient echo(3D-T1W1-MPGAGE)sequence and three-dimensional pseudo continuous ASL sequence.The 3D-T1W1-MPGAGE imaging were automatically segmented.Two physicians used the freeview visualization interface of freeSurfer software to fuse the ROI and ASL functional images of the hippocampal subregions and to measure the CBF values.The intra-observer and inter-observer consistency and repeatability were evaluated and analyzed.The consistency analysis and repeatability evaluation were performed via intraclass correlation coefficient(ICC),Bland-Altman diagram and Wilcoxon rank sum test.Results The ICC of CBF values measured by two physicians were all>0.750,with an average of 0.868±0.095.The ICC of left and right hippocampal subregions were as follows:subiculum(SUB):0.818/0.801,cornu ammonis(CA)1:0.920/0.907,CA2-3:0.759/0.978,CA4:0.757/0.758 and dentate gyrus(DG):0.990/0.991;The ICC delineated by the same physician's ROI were all>0.990 with an average of 0.994±0.002.The ICC of left and right hippocampal subregions were as follows:SUB:0.993/0.993,CA1:0.996/0.995,CA2-3:0.989/0.994,CA4:0.992/0.995 and DG:0.993/0.996.The Bland-Altman diagram showed the scatter distribution and consistency,and the coefficient of repeatability was obtained.The same observer had certain repeatability for the fusion measurement of automatic segmentation ROI and ASL functional images.Conclusion The CBF values measured by fusing ROI and ASL functional images of automatically segmented hippocampal subregion have higher consistency and repeatability.

Postmortem redistribution of amantadine in rats / 中国法医学杂志

Objective To establish an animal model of postmortem redistribution of amantadine,and to study its postmortem redistribution in rats,so as to provide experimental evidence for forensic identification.Methods One hundred and twenty-six male SD rats were randomly divided into 3 groups and subjected to intragastric administration according to the maximum dose of treatment(L),LD50(M)and 2LD50(H).Those who did not die were killed according to the average time of death of LD50.Heart-blood,peripheral blood,heart,liver,spleen,lung,kidney,brain,muscle and testis were collected at 0 h,6 h,12 h,24 h,48 h,72 h and 96 h after death,and amantadine content was detected.Results For the rats in the L group,the concentration of amantadine decreased within 6 h after death and then increased in the heart-blood,heart and liver,unchanged within 48 h and reached the peak at 96 h in the spleen,kidney,brain,muscle and testis,while decreased in the lung.For the rats in the M group,the concentration of amantadine decreased within 24 h after death and then increased in all samples,and it reached the peak at 48 h after death in the peripheral blood,spleen,kidney and muscle tissues,at 72 h after death in the heart-blood and testis,and at 96 h after death in the liver,lung and brain tissues.For the rats in the H group,the concentration of amantadine showed a downward trend within 12 h after death in the heart and liver tissue,showed a downward trend within 48 h after death in the lung,brain and muscle tissue,and reached the peak at 96 h after death in the heart,liver,spleen,muscle and testicle tissues.Conclusion The postmortem redistribution was found in amantadine poisoning dead rats,which could provide experimental evidence for the forensic identification of death cases caused by amantadine poisoning.

Hemorrhage resulted from cortical venous infarction with seizure as first symptom after craniotomy: a clinical analysis of 11 patients / 中华神经医学杂志

Objective:To summarize the clinical characteristics and efficacy of hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy.Methods:Eleven patients with hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy admitted to Neurosurgical Center, 988 th Hospital of PLA Joint Logistic Support Force from June 2011 to September 2019 were chosen in our study; primary diseases included meningioma in 7 patients, contusion and laceration of frontal lobe in 2, hypertensive cerebral hemorrhage in 1, and obsessive-compulsive disorder in 1 patient. Epilepsy was the first symptom after craniotomy. Clinical characteristics and efficacy of these patients were analyzed retrospectively; seizure control efficacy was evaluated by Engel grading. Results:First seizure occurred 4 h-7 d after craniotomy in these 11 patients, including 2 with focal sensory retention seizure, 3 with focal bilateral tonic-clonic seizure, and 6 with general tonic-clonic seizure. Follow-up cranial CT revealed hematoma in surgical region, adjacent cortex or subcortex in 9 patients (hematoma volume: 15-50 mL); emergency craniotomy (hematoma clearance) and decompressive craniectomy was performed in 5 patients; only emergency craniotomy (hematoma clearance) was performed in 3 patients; conservative treatment was performed in 1 patient. A small amount of diffuse bleeding with severe cerebral edema in the surgical region appeared in 2 patients, and the transient limb paralysis gradually recovered after 2 months of conservative treatment. Follow-up was performed for (4.5±1.7) years ([2.3-7.0] years). During the last follow-up, 4 patients were normal, 5 patients had mild to moderate hemiplegia, 1 had mild decreased vision in the right eye, and 1 had long-term coma. Epileptic control efficacy analysis indicated that 8 had Engel grading I and 3 grading II.Conclusion:Complete removal of hematoma and inactivated brain tissues can effectively control seizures and rebleeding in patients with hemorrhage resulted from cortical venous infarction.

Effect of matrine on proliferation, apoptosis and radiotherapy sensitivity of uveal melanoma cells / 中华眼底病杂志

Objective:To investigate the effects of matrine on proliferation, apoptosis and radiotherapy sensitivity of uveal melanoma cells.Methods:An animal experiment study. In vitro experiment: MuM2B cells of human choroidal melanoma were randomly divided into control group and matrine 0.25, 0.50, 1.00, 2.00 g/L groups. The cell morphology was observed by transmission electron microscope. Cell proliferation was detected by thiazole blue colorimetry. The mRNA and relative expression levels of CyclinD D (CyclinD), B lymphoblastoma-2 (Bcl-2) and Bcl2-associated X protein (Bax) were detected by real-time polymerase chain reaction and Western blot. In vivo experiment: BALB/C mice were injected with MuM2B cell suspension subcutaneously on the back of forelimb to prepare transplanted tumor model. After successful modeling, they were randomly divided into blank group and matrine treatment group with different concentrations. Mice in blank group were injected with phosphate buffer subcutaneously. Mice in different matrine treatment groups were injected with 15, 25, 50, 100 mg/kg matrine subcutaneously, respectively, for 7 consecutive days. The tumor was weighed and its volume was measured after the last administration. Single factor analysis of variance was used to compare different groups. The t test was used for pairwise comparison between groups. Results:In the control group, the cell structure was normal, the distribution was uniform, and no or rare nuclear pyknosis was seen. With the increase of matrine dosage, the nuclear pyretosis increased gradually and cell morphology changed obviously. Compared with the control group, the cell survival rate in 0.50, 1.00 and 2.00 g/L groups gradually decreased with matrine concentration increasing and treatment time prolongating, the relative expression levels of CyclinD and Bcl-2 mRNA and protein gradually decreased, and the relative expression levels of Bax mRNA and protein gradually increased. Under the same radiation dose X-ray irradiation, the cell survival rate of 0.50, 1.00 and 2.00 g/L groups gradually decreased, and the differences were statistically significant ( P<0.05). Compared with blank group, the tumor weight and volume of mice in different doses of matrine group were significantly decreased, and the differences were statistically significant ( P<0.05). Conclusion:Matrine can down-regulate the expression of CyclinD and Bcl-2, up-regulate the expression of Bax, promote the apoptosis of MuM2B human melanoma cells, inhibit cell proliferation, and enhance cell radiosensitivity.

Assessment of residual risk of hepatitis C virus transmission by blood transfusion in Taiyuan / 中国输血杂志

【Objective】 To analyze the epidemic of hepatitis C virus (HCV) in voluntary blood donors , and to assess the residual risk of HCV transmission by blood transfusion in Taiyuan. 【Methods】 The HCV screening results of voluntary blood donors in Taiyuan from 2016 to 2021 were collected by blood center information system, and the epidemiologic feature of first-time and repeated donors were analyzed. The incidence-window period model was used to assess the residual risk of HCV transmission by transfusion in first-time/repeated donors as well as that in repeated donors under different blood screening modes. 【Results】 Of the 662 705 samples in Taiyuan from 2016 to 2021, the HCV positive rate of the first-time donors was 1.83‰(595/325 009) and the residual risk of HCV transmission was 14.91/100 000. The HCV positive rate of the repeated donors was 0.04‰ (13/337 696) and the residual risk was 0.31/1 000 000. The total residual risk of HCV transmission was 7.47/1 000 000. A total of 337 696 blood samples of repeated blood donors were tested, the repeated blood donors’ residual risk of transfusion-transmitted HCV was 0.31/100 000 after dual ELISA tests , and 0.06/100 000 after dual ELISA and once NAT, which reduce by 80.65% since NAT were adopted. 【Conclusion】 The residual risk of HCV transmission from repeated donors was less than that from first-time donors. The blood screening mode of HCV by dual ELISA and once NAT can effectively reduce the residual risk of transfusion-transmitted HCV and improve blood safety. The rate of repeat blood donation needs to be increased by continuously optimizing the recruitment strategy of blood donors.

Long-term outcomes of laparoscopic ventral rectopexy for obstructive defecation with overt pelvic structural abnormalities / 中华消化外科杂志

Objective:To investigate the long-term outcomes of laparoscopic ventral rectopexy (LVR) for obstructive defecation with overt pelvic structural abnormalities.Methods:The retrospective cohort study was conducted. The clinical data of 31 obstructive defecation patients with overt pelvic structural abnormalities who were admitted to the Renji Hospital of Shanghai Jiaotong University School of Medicine from June 2014 to August 2020 were collected. There were 6 males and 25 females, aged 59(range, 32?81)years. All 31 patients underwent LVR through transabdominal approach. Observation indicators: (1) the Cleveland clinic constipation score (CCCS); (2) severity of obstructive defecation; (3) patients assessment of constipation quality of life (PAC-QoL). Follow-up was conducted using telephone interview and outpatient examination up to October 2021. One professional researcher assessed the constipation symptoms and quality of life of patients through outpatient interview or mobile software platform of Questionnaire Star. Measurement data with skewed distribution were represented as M(range), and comparison before and after operation was conducted using the Wilcoxon sign rank test. Results:(1) The CCCS. All 31 patients underwent LVR for the first time and were followed up for 61.8(range, 11.0?87.0)months. The constipation symptoms of the 22 patients were improved. The CCCS of the 31 patients before surgery and at the last follow-up time were 15.8(range, 8.0?26.0) and 10.7(range, 2.0?20.0), respectively, showing a significant difference ( Z=?3.98, P<0.05). (2) Severity of obstructive defecation. The severity scores of frequency of bowel movements, difficult of bowel movements, sensation of incomplete defecation, abdominal distension or pain, time of each bowel movements, daily unsuccessful times of defecation, artificial assisted defecation for the 31 patients were 2.9(range, 1.0?4.0), 3.0(range, 1.0?4.0), 1.9(range, 0?3.0), 0.5(range, 0?3.0), 2.6(range, 2.0?4.0), 2.0(range, 0?4.0), 0.9 (range, 0?2.0) before surgery, versus 1.7(range, 0?4.0), 1.6(range, 0?4.0), 1.2(range, 0?4.0), 0.3(range, 0?3.0), 1.7(range, 0?3.0), 1.4(range, 0?3.0), 0.7(range, 0?2.0) after surgery, respectively. There were significant differences in the frequency of bowel movements, difficult of bowel movements, sensation of in-complete defecation, abdominal distension or pain, time of each bowel movements, daily unsuccessful times of defecation for the 31 patients before and after surgery ( Z=?3.38, ?3.80, ?2.54, ?2.31, ?3.64, ?2.75, P<0.05) and there was no significant difference in the artificial assisted defecation for the 31 patients before and after surgery ( Z=?1.31, P>0.05). (3) PAC-QoL. The score of physical discomfort, satisfaction, worries and concerns, psychological discomfort for the 31 patients were 2.3(range, 1.0?4.0), 3.2(range, 1.0?4.8), 2.2(range, 0.6?4.0), 1.8(range, 0.4?3.9) before surgery, versus 1.6(range, 0?4.0), 2.3(range, 0?4.0), 1.7(range, 0?4.0), 1.3(range, 0?4.0)after surgery, respectively, showing significant differences before and after surgery ( Z=?3.49, ?2.17, ?2.50, ?3.05, P<0.05). Conclusions:The long-term outcomes of LVR for obstructive defecation with overt pelvic structural abnorma-lities are satisfactory. Symptoms as frequency of bowel movements, difficult of bowel movements, sensation of incomplete defecation, abdominal distension or pain, time of each bowel movements and daily unsuccessful times of defecation will be significantly improved after LVR and the constipation quality of life of patients will be improved.

Application value of self-pulling and latter transection technique in double anti-reflux double-tract reconstruction of totally laparoscopic proximal gastrectomy / 中华消化外科杂志

Objective:To investigate the application value of self-pulling and latter transection (SPLT) technique in double anti-reflux double-tract reconstruction of totally laparoscopic proximal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 103 patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction in clinical stage Ⅰ-Ⅱ who were admitted to Shanxi Cancer Hospital from January 2018 to January 2020 were collected. There were 65 males and 38 females, aged from 45 to 79 years, with a median age of 59 years. Of 103 patients, 49 cases undergoing totally laparoscopic proximal gastrectomy with double-tract reconstruction of SPLT were assigned into the SPLT group, 54 cases undergoing totally laparoscopic proximal gastrectomy with conventional double-tract reconstruction were assigned into the traditional group. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Follow-up was conducted by outpatient examination and telephone inter-view to detect postoperative reflux esophagitis of patients up to December 2021. Measurement data with normal distribution were represented as Mean± SD, and the t test was used for comparison between groups. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and the Wilcoxon test was used for comparison between groups. Count data were described as absolute numbers or percentages, and comparison between groups was performed using the chi-square test. Comparison of ordinal data was analyzed using the non-parameter rank sum test. Results:(1) Intraoperative situations: the operation time, digestive tract reconstruction time, volume of intraoperative blood loss, the number of inferior mediastinal lymph nodes dissected, cases with auxiliary incisions for the SPLT group were (261±48)minutes, (26±4)minutes, (114±42)mL, 8.0(6.5,9.5), 1, respectively. The above indicators were (244±42)minutes, (30±6)minutes, (118±46)mL, 5.5(4.0,8.0), 9 for the traditional group, respectively. There were significant differences in the digestive tract reconstruction time, the number of inferior mediastinal lymph nodes dissected and cases with auxiliary incisions between the two groups ( t=-3.34, Z=-4.05, χ2=4.72, P<0.05). There was no significant difference in the operation time or volume of intraoperative blood loss between the two groups ( t=1.87, -0.47, P>0.05). (2) Postoperative situations: duration of postopera-tive hospital stay and cases with postoperative complications were (11.5±2.7)days and 4 for the SPLT group, versus (12.5±4.3)days and 9 for the traditional group, showing no significant difference between the two groups ( t=-1.47, χ2=1.68, P>0.05). There were 13 of 103 patients with postopera-tive complications, including 5 cases of left pleural effusion, 4 cases of anastomotic leakage, 2 cases of mild pneumonia, 1 case of incision infection, 1 case of chylous leakage. Four patients had anasto-motic leakage at the esophagojejunostomy, the abdominal esophagus of whom was invaded by more than 1 cm. During the operation, mediastinal drainage tubes were placed through the abdominal wall. The 4 patients were cured after enteral and parenteral nutrition support and adequate drainage, and the remaining patients with complications were cured after symptomatic treatment. (3) Follow-up: of 49 patients in the SPLT group, 43 cases were followed up for (18±4)months. During the follow-up, 1 case showed reflux esophagitis by gastroscopy, with the incidence of 2.33%(1/43). Of 54 patients in the traditional group, 53 cases were followed up for (17±4)months. During the follow-up, 4 cases showed reflux esophagitis by gastroscopy, with the incidence of 7.55%(4/53). There was no significant difference in the incidence of reflux esophagitis between the two groups ( χ2=0.47, P>0.05). Conclusions:SPLT technology is feasible for double anti-reflux double-tract reconstruction of proximal gastrectomy. Compared with traditional double-tract reconstruction of totally laparos-copic proximal gastrectomy, SPLT technology can reduce the auxiliary incisions, increase the number of lower mediastinal lymph nodes dissected, and shorten the digestive tract reconstruction time.

Association between plasma trimethylamine-N-oxide level and premature coronary heart disease / 中华全科医师杂志

Objective:To investigate the associations between plasma trimethylamine-N-oxide (TMAO) level and premature coronary heart disease (PCHD).Methods:From July 2018 to July 2020, total of 166 patients with suspected coronary heart disease were enrolled from the Heart Center of Shenzhen Bao′an Hospital affiliated to Southern Medical University. According to the coronary imaging results and age of onset, they were divided into young control group ( n=30), PCHD group ( n=49), middle-aged and elderly control group ( n=30) and the middle-aged and elderly coronary heart disease group ( n=57). Plasma TMAO concentration in each group was determined by stable isotope liquid chromatography/mass spectrometry, and the correlation of plasma TMAO level with PCHD and SYNTAX score was analyzed. Results:The plasma TMAO level in PCHD group was significantly higher than that in young control group [(7.54±2.10) μmol/L vs. (4.60±1.89) μmol/L; t=6.73, P?0.001] and middle-aged and elderly coronary heart disease group [(3.90±1.75) μmol/L; t=2.45, P=0.015]. The plasma TMAO level was positively correlated with SYNTAX score in PCHD group ( r=0.66, P?0.001) and in middle-aged and elderly coronary heart disease group ( r=0.27, P=0.042). Multivariate logistic regression analysis showed that plasma TMAO level was an independent risk factor for PCHD ( OR=2.30, P?0.001). Receiver operating characteristic (ROC) curve analysis showed that when the cutoff level of plasma TMAO was 6.08 μmol/L, the sensitivity and specificity for diagnosis of PCHD were 73.5% and 76.7%, respectively. Conclusion:The plasma TMAO level is significantly correlated with PCHD and had certain predictive value for PCHD.

Effect of Fuzitang on Proliferation of Human Rheumatoid Arthritis Synovial Fibroblast Cell Line MH7A and Expression of miR-155 / 中国实验方剂学杂志

ObjectiveTo observe the effects of Fuzitang （FZT） on the proliferation of MH7A cells， the human rheumatoid arthritis synovial fibroblasts， and the expression of miR-155 and explore its anti-rheumatoid arthritis mechanism. MethodMH7A cells were cultured in vitro and divided into a blank group， high- （25 g·L-1） and low-dose （12.5 g·L-1） FZT groups， and a positive drug group （hydroxychloroquine， 0.006 25 g·L-1）. The cell proliferation was detected by cell counting kit-8（CCK-8） method， and the change in the MH7A cell cycle was detected by flow cytometry. The mRNA expression of miR-155 and its downstream genes， including SH2 domain-containing inositol 5-phosphatase-1（SHIP-1）， protein kinase B 3（Akt3）， and mammalian target of rapamycin（mTOR）， was detected by Real-time fluorescence quantitative polymerase chain reaction（Real-time PCR）， and the protein expression of phosphatidylinositol 3-kinase （PI3K）， Akt3， and mTOR was detected by Western blot. ResultFZT in vitro in a concentration of 6.25 g·L-1 above could inhibit the proliferation of MH7A cells in the significant dose- and time-effect manner. Compared with the blank group， the FZT groups showed increased proportions of cells in the G2/M phase （P<0.05）， and the high-dose FZT group showed a decreased proportion of cells in the G0/G1 phase （P<0.05）. The arresting effect of FZT on the cell cycle was in a significant dose-effect manner. Compared with the blank group， the FZT groups showed down-regulated miR-155 and mTOR mRNA expression （P<0.05）， and the high-dose FZT group showed up-regulated SHIP1 mRNA expression and down-regulated Akt3 mRNA expression （P<0.05）. Compared with the blank group， the FZT groups showed reduced protein expression of PI3K， Akt3， and mTOR （P<0.05）. ConclusionFZT can significantly inhibit the proliferation of MH7A cells， and the mechanism is related to the promotion of the expression of SHIP-1 and down-regulation of the gene expression of the PI3K/Akt3/mTOR signaling pathway by down-regulating the expression of miR-155.

Effect of Gastrointestinal Rehabilitation on Quality of Life, Substance P and 5-Hydroxytryptamine in Constipation Patients After Stroke / 胃肠病学

Background: Post - stroke constipation is a commonly seen complication, which can reduce the quality of life of patients. Therefore, it is particularly important to explore the treatment of post-stroke constipation. Aims: To explore the effect of gastrointestinal rehabilitation (visceral fascial manipulation plus middle - frequency electrical stimulation) on quality of life, substance P (SP) and 5-hydroxytryptamine (5-HT) in constipation patients after stroke. Methods: Seventy constipation patients after stroke from Oct. 2020 to Oct. 2011 at Shanghai Tongren Hospital were enrolled and randomly divided into control group (lactulose treatment) and treatment group (gastrointestinal rehabilitation treatment). Montreal cognitive assessment (MoCA), Barthel index (BI), self-rating anxiety/depression scale (SAS/SDS), gastrointestinal symptom rating scale (GSRS), Wexner constipation scale, and patient assessment of constipation-quality of life (PAC-QOL) were performed before and after treatment. Serum SP, 5 - HT were determined by ELISA. Results: After the treatment, no significant difference in MoCA score was found in both two groups, and SAS score, SDS score, GSRS score, Wexner score and PAC-QOL score were significantly decreased (P0.05). Serum SP, 5-HT levels in treatment group were significantly higher than those in control group (P<0.05). Conclusions: In the treatment of constipation after stroke, the gastrointestinal rehabilitation therapy of‘visceral fascial manipulation plus middle-frequency electrical stimulation’has the therapeutic effects equivalent to drug therapy, and is worthy for promoting in clinical treatment.

Effect of knee arthroplasty on serum cytokines and quality of life in Kashin-Beck disease patients with severe knee arthritis / 中华地方病学杂志

Objective:To explore the effect of knee arthroplasty on serum cytokines and quality of life in Kashin-Beck disease (KBD) patients with severe knee arthritis.Methods:In a prospective design, KBD patients with severe knee arthritis who underwent total knee arthroplasty in Quzhou Hospital of Traditional Chinese Medicine from June 2017 to June 2018 were selected as the study subjects. The levels of serum cytokines [interleukin-1β (IL-1β), tumor necrosis factor (TNF)-α] and nitric oxide (NO) were compared before operation, 6 months after operation and 1 year after operation. The scores of Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and quality of life scale (KBDQOL) were evaluated.Results:The age of 34 KBD patients with severe knee arthritis was (60.4 ± 5.6) years old, ranged from 50 to 72 years old. There were 15 males and 19 females; the course of disease was (20.3 ± 10.5) years, ranged from 5 to 40 years. The levels of serum IL-1β [(16.49 ± 3.86), (12.08 ± 1.27) pg/ml], TNF-α [(9.28 ± 1.45), (6.52 ± 1.26) pg/ml] and NO [(63.58 ± 15.82), (43.84 ± 10.37) μmol/L] at 6 months and 1 year after operation were significantly lower than those before operation [(21.65 ± 5.08), (13.06 ± 2.15) pg/ml, (102.16 ± 20.74) μmol/L, P < 0.05], and the levels of the above indicators at 1 year after operation were significantly lower than those at 6 months after operation ( P < 0.05). The WOMAC dimensions and comprehensive scores of KBD patients at 6 months and 1 year after operation were significantly lower than that before operation ( P < 0.05), and the WOMAC dimensions and comprehensive scores at 1 year after operation were significantly lower than those at 6 months after operation ( P < 0.05). The social support, activity limitation, somatic function, mental status, overall health and total scores of patients at 6 months and 1 year after operation were significantly higher than those before operation ( P < 0.05). The overall health and total scores of patients at 1 year after operation were significantly higher than those at 6 months after operation ( P < 0.05). Conclusion:After total knee arthroplasty, the inflammatory reaction, clinical symptoms and quality of life of KBD patients with severe knee arthritis are significantly improved.

Clinical analysis of 27 preschoolers with refractory temporal lobe epilepsy / 中华神经医学杂志

Objective:To investigate the imaging and electrophysiological characteristics, surgical methods and efficacies of preschoolers with refractory temporal lobe epilepsy.Methods:A retrospective data study was conducted on 27 patients with refractory temporal lobe epilepsy accepted surgical treatment in our hospital from June 2014 to January 2019. By combined with clinical manifestations, preoperative epileptogenic zones were evaluated by imaging data, such as MR imaging, MR spectroscopy and positron emission tomography-CT, and interictal and ictal video-electroencephalogram (VEEG) data. During the surgery, cortical electroencephalography (ECoG) and deep electrode monitoring were used to monitor and locate the abnormal discharge areas to guide the surgical excision of epileptic zone. Engel grading was used to evaluate the efficacy after surgery.Results:All children had typical clinical manifestations of temporal lobe epilepsy; abnormal signal images were found in one side of the temporal lobe and the hippocampus in MR imaging; epileptic discharges were originated from one side frontotemporal region in interictal and ictal VEEG. Obviously persistent or paroxysmal spike waves, spike waves and slow spikes and spike composite waves were intraoperatively discovered by ECoG and depth electrode electroencephalography in the temporal lobe. All patients accepted standard anterior temporal lobectomy+lesion resection+peripheral abnormal discharge resection of the temporal lobe cortex; partial insular lobe was excised and frontal cortex was performed low power thermal coagulation in two patients. Follow-up was performed for 6 months; Engel grading I was reported in 22 patients (81.5%), Engel grading II in 3 patients (11.1%), and Engel grading III in 2 patients (7.4%).Conclusion:Early surgery and moderate extension of resection under intraoperative ECoG and deep electrode monitoring are the key factors to improve the surgical efficacy of preschoolers with refractory temporal lobe epilepsy.

Desmoplastic nodule associated with intradermal nevus: a case report / 中华皮肤科杂志

A 28-year-old male patient presented with a 4-year history of a solitary brown mass, and a 1-year history of multiple small papules on the left chest. Skin examination showed a quasi-round brown firm mass measuring about 1.2 cm × 1.1 cm × 1.0 cm in size on the left chest, and several brown papules with diameters ranging from 3 to 5 mm on the right side of the mass; no enlarged lymph nodes were detected in the left axilla on palpation. The mass and papules were completely resected, and histopathological examination showed clustered nevus cells in the superficial dermis of the mass and small papules, and the diagnosis of intradermal nevus was considered. There was a desmoplastic nodule in the mass, nevus cells were scattered among the fibers in the nodule, and giant nevus cells were also observed; the nevus cells in the nodule were relatively larger, epithelioid or spindle-shaped with round or spindle-shaped nuclei, obvious nucleoli, and rare mitotic figures. Immunohistochemical study showed that the nevus cells in both the intradermal nevus and proliferative nodule were positive for S100; the nevus cells in the superficial dermis of the intradermal nevus were positive for Melan-A and HMB45, while the nevus cells in the proliferative nodule were negative for Melan-A and HMB45; both the intradermal nevus and proliferative nodule tissues showed a Ki-67 index of 1%, positive staining for CD34, but negative staining for P16 and P63. Finally, the patient was diagnosed with intradermal nevus associated with desmoplastic nodule.

Advances in Studies on Short-chain Fatty Acids in Inflammatory Bowel Disease / 胃肠病学

Inflammatory bowel disease (IBD) is a chronic inflammatory disease driven by genetic and environmental factors. Short-chain fatty acids (SCFAs), which are produced by fermentation of dietary fiber by intestinal microbiota, have anti-inflammatory effect and are involved in the maintenance of intestinal homeostasis. Intestinal inflammation and low fiber diet can reduce the number of SCFAs-producing bacteria and thereby affecting intestinal immune and metabolic regulation. This article reviewed the advances in studies on SCFAs in IBD.

Correlation of visceral fat distribution and carotid artery elasticity in severely abdominal obese children by RF-data based quantitative analysis on vessel stiffness / 中华超声影像学杂志

Objective:To evaluate the carotid artery elasticity in severely abdominal obese children by RF-data based quantitative analysis on vessel stiffness (R-VQS), and explore the correlation between visceral fat distribution and carotid artery elasticity.Methods:Seventy severely abdominal obese children aged 7-14 years old and 55 healthy children with normal body mass index were selected as obese group and control group in Children′s Hospital Affiliated to Zhengzhou University from July 2018 to July 2019. Epicardial fat thickness (EFT), visceral fat thickness (VFT), subcutaneous fat thickness (SFT), maximum preperitoneal fat thickness (PFTmax), minimum subcutaneous fat thickness (SFTmin), perirenal fat thickness (PRFT) were measured by ultrasound. Real-time intima-media thickness (RIMT) and R-VQS were employed to evaluate common carotid intima-media thickness (IMT), systolic diameter (Diam), distance (Dist), pulse wave velocity (PWV) and hardness coefficient (HC). The correlation between fat thickness and carotid artery elasticity was analyzed.Results:There were statistically differences of common carotid IMT, elasticity parameters (IMT, Diam, Dist, PWV, HC) and fat thickness (EFT, VFT, SFT, PFTmax, SFTmin, PRFT) between two groups ( P<0.05). In obese children, PFTmax, VFT, EFT, PRFT were positively correlated with IMT, PWV, and HC (with IMT: r=0.334, 0.425, 0.415, 0.370, P<0.05; with PWV: r=0.853, 0.744, 0.590, 0.358, P<0.05; with HC: r=0.822, 0.691, 0.526, 0.320, P<0.05), and there was no correlation between SFT, SFTmin and IMT, PWV, HC( P>0.05). The degree of correlations between visceral fat thickness and carotid artery elasticity was PFTmax>VFT>EFT>PRFT, however, the correlations between EFT, PRFT and carotid elastic elasticity were weak ( r<0.7). Conclusions:R-VQS can sensitively reflect the carotid artery elasticity in severely abdominal obese children, and it can be used as an important reference indicator for early evaluation of atherosclerosis in obese children. Their visceral fat thickness (EFT, PRFT, VFT and PFTmax) have a good correlation with carotid artery elasticity, among which PFTmax has the best correlation and shows a certain clinical significance for the treatment and follow-up of obese children.

Study on the mechanism of miR-29a/HMGB1 signaling pathway on H9C2 cardiomyocyte fibrosis induced by high glucose and high fat / 中国临床药理学与治疗学

AIM: To investigate the role of miR-29a/HMGB1 signaling pathway in fibrosis H9C2 cells induced by HGHL. METHODS: DMEM medium containing glucose (33 mmol/L) and palmitate (500 μmol/L) was used to intervene in H9C2 cells for 24 h for subsequent experiments. There were 8 experimental groups, namely NC group, HGHL group, miR-NC group, mimics group, inhibitor group, pc-HMGB1 group, si-HMGB1 group, and miR-29a mimics+pc-HMGB1 group. Flow cytometry was used to detect the apoptosis rate of H9C2 cells in each group. The Western blot experiment detected the expression of TGF-β1, CTGF, MMP-9, PPARγ, and HMGB1 in H9C2 cells of each group. RT-qPCR detected the expression levels of miR-29a, TGF-β1, CTGF, MMP-9, PPARγ, HMGB1 mRNA in each group of cells. The scratch test was used to detect the migration ability of H9C2 cells in each group. RESULTS: After HGHL intervention, the apoptosis rate of H9C2 cells was significantly increased (P< 0.05), and the cell migration ability was significantly enhanced (P< 0.05). The expression level of TGF-β1, CTGF, and MMP-9 mRNA in cells increased significantly (P< 0.05), but the expression level of PPARγ mRNA decreased significantly (P< 0.05), and the expression of corresponding proteins also changed with the changes in mRNA (P< 0.05). Besides, the expression level of miR-29a in H9C2 cells was also significantly reduced (P< 0.05). After the transfection of miR-29a mimics, the increase in apoptosis rate of H9C2 cells caused by HGHL intervention was significantly inhibited (P< 0.05), and the cell migration ability was also significantly inhibited (P< 0.05). Compared with the HGHL group, TGF-β1, CTGF, and MMP-9 protein expression and mRNA expression levels in H9C2 cells were significantly lower (P< 0.05), and PPARγ protein expression and mRNA expression levels were significantly increased (P< 0.05). Transfection of miR-29a inhibitor promoted the fibrosis process of H9C2 cells induced by HGHL. miR-29a negatively regulated the expression of HMGB1 protein and its mRNA in H9C2 cells. The results of dual-luciferase reporter gene experiments showed that HMGB1 was a downstream target gene of miR-29a. Transfection of si-HMGB1 and miR-29a mimics had similar effects on H9C2 cell fibrosis induced by HGHL. Simultaneous transfection of miR-29a mimics and pc-HMGB1 had no significant effect on H9C2 cardiomyocyte fibrosis induced by HGHL. CONCLUSION: HGHL intervention can significantly increase the apoptosis rate of H9C2 cells, enhance their migration ability, and the process of fibrosis. At the same time, HGHL intervention can significantly down-regulate the expression level of miR-29a in cells, miR-29a negatively regulates the expression of HMGB1 in cells and then affects HGHL-induced H9C2 cell fibrosis.

Layer-specific strain assessment of left ventricular systolic function in patients with bicuspid aortic valve / 中华超声影像学杂志

Objective To quantitatively evaluate left ventricular ( LV ) systolic function in bicuspid aortic valve (BAV) using layer-specific strain ( LSS) . Methods Thirty BAV patients were divided into normal function (NF) group (10 cases) and non-normal function (N-NF) group (20 cases) based on aortic valvular lesion types ,and 20 healthy volunteers were taken as control group . Longitudinal strain( LS) and circumferential strain (CS) of three-layer myocardium and full thickness myocardium were assessed using layer-specific speckletracking imaging ,available by GE Vivid E9 and EchoPac workstation . Results There was no significant difference in left ventricular ejection fraction( LVEF) among the N-NF group ,NF group and control group ( P > 0 .05) ,all of them within the normal range[(63 .3 ± 7 .1)％ ,(64 .6 ± 6 .2)％ , ( 65 .3 ± 3 .9)％ ] . It showed a gradient decrease from the endocardium to the epicardium in both control and BAV group . LS of endocardium ( LSendo) and LS of epicardium ( LSepi) in N-NF group and NF group were significantly reduced compared with those in control group ( P <0 .05) [ LSendo :( -21 .19 ± 3 .12)％vs ( -23 .06 ± 2 .07 )％ vs ( -25 .53 ± 2 .51 )％ ;LSepi:( -16 .08 ± 2 .68 )％ vs ( -18 .85 ± 2 .12 )％ vs ( -20 .72 ± 2 .28)％ ] . Compared with control group ,there was no significant difference in NF group in CS of the three-layer myocardial and full-thickness myocardium as well as the LS of the whole medial myocardial layers and full-thickness ( P > 0 .05 ) . Compared with NF group [ CS :( -19 .57 ± 2 .9 )％ vs ( -13 .43 ± 2 .19)％ vs ( -20 .03 ± 3 .04)％ ;LS :( -21 .38 ± 2 .05)％ vs ( -18 .85 ± 2 .12)％ vs ( -21 .09 ± 2 .03)％ ] and control group[CS :( -21 .63 ± 3 .01)％ vs ( -14 .34 ± 2 .55)％ vs ( -21 .48 ± 2 .16)％ ;LS :( -22 .18 ± 2 .30 )％ vs ( -20 .72 ± 2 .28 )％ vs ( -22 .89 ± 2 .30 )％ ] , CS [ ( -16 .78 ± 3 .65 )％ vs ( -11 .40 ± 3 .78 )％ vs ( -15 .83 ± 2 .61 )％ ] and LS [ ( -18 .34 ± 2 .85 )％ vs ( -16 .08 ± 2 .68 )％ vs ( -18 .51 ± 2 .86)％ ] of middle myocardium ,epicardial myocardium and full-thickness myocardium in N-NF group were decreased significantly ( P < 0 .05) . Conclusions It is essential to maintain normal valvular function to prevent the progress of myocardial deterioration . LSendo and LSepi can be used to sensitively identify early left ventricular systolic dysfunction in BAV patients with normal LVEF .

Three-dimensional finite element analysis of cantilever fixed bridge supported by implants with mandibular central incisor / 中华口腔医学杂志

Objective@#To investigate effect of the contact surface between the bridge and the adjacent teeth on the stress distribution of the implant and bone tissue and the displacement of the prosthesis in the cantilever fixed implant bridge restoring missing mandibular central incisors.@*Methods@#Two-dimensional images of the mandible and dentition in healthy adults were obtained using CT data. A three-dimensional finite element model of cantilever fixed bridge supported by implants with mandibular central incisor was established by computer reconstruction technique.The contact surface between the bridge and the adjacent natural tooth was designed as "oval" and "trapezoid". The "trapezoid" has a slightly smaller median diameter on the labial side and a slightly larger medial diameter on the lingual side. Loading of 120 N was applied on the tangential margin of the middle line of the long axis of the bridge 41. The direction was set at 0°, which was parallel to the long axis of the tooth and downward. The buccal to lingual and downward angles were 30°, 45° and 60°, respectively, perpendicular to the long axis of the tooth and 90° to the lingual side.The stress distribution of the implant and surrounding bone tissue and the displacement of the prosthesis were compared between the two models.@*Results@#Under axial and buccolingual loading, the maximum equivalent stress peak in the implant and surrounding bone tissue in the cantilever with trapezoidal contact surface design and the maximum displacement of the prosthesis were lower. Moreover, the distribution of stress was more balanced and the concentration range of stress was smaller. With the loading angle increasing, this trend was more obvious. When loading angle increased to 90°, the maximum equivalent stress and the maximum displacement of the elliptic contact surface model implant and surrounding bone tissue were 196 and 101 MPa and 0.196 mm, respectively, while the trapezoidal contact surface model were 157 and 72 MPa and 0.164 mm, respectively.@*Conclusions@#The trapezoidal contact surface of the bridge and the adjacent teeth in the cantilever fixed bridge supported by implants with mandibular central incisor is beneficial to reduce the impact of the leverage on the implant and surrounding bone tissue.

Efficacy and safety of nalbuphine on analgesia of patients in intensive care unit / 中华危重病急救医学

Objective To analyze the efficacy and safety of nalbuphine in patients with sedative analgesia in intensive care unit (ICU). Methods A prospective observation was conducted. The adult patients with mild and moderate analgesia in general ICU of the First Affiliated Hospital of Zhengzhou University from January to November in 2017 were enrolled, and they were divided into nalbuphine group and sufentanil group in proper order. The nabobrown group was given 40 mg nabobrown, the sufentanil group was given 0.1 mg sufentanil, both of which were injected with 50 mL normal saline for continuous intravenous infusion in micro-pump. Infusion speed was checked according to pain level. The analgesic target was critical-care pain observation tool (CPOT) score < 2. The change in hemodynamics of patients in both groups were observed, and CPOT score and Richmond agitation-sedation scale (RASS) score were recorded before and l, 3, 5, 12, 24 hours after administration. The analgesic and sedative effects of two drugs were evaluated. Results A total of 141 patients were enrolled, including 71 patients in nalbuphine group and 70 in sufentanil group. There was no significant difference in general data including gender, age, body weight, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) or pain source, as well as baseline hemodynamics parameter between the two groups. At 1 hour and 3 hours after administration, nalbuphine had no effect on blood pressure, but the heart rate was decreased slightly, while the heart rate and blood pressure of the sufentanil group were decreased obviously. The two drugs could make the heart rate and blood pressure fluctuate obviously with the time of medication, but there was no statistical difference between the two drugs. The two drugs had no significant effect on pulse oxygen saturation (SpO2) during analgesia. The average dosage of nalbuphine was 0.03 (0.02, 0.05) mg·kg-1·h-1in the nalbuphine group, and the patient was satisfied with the analgesic effect until 3 hours after the use of the drug, and CPOT score was significantly decreased as compared with that before administration [1.0 (1.0, 2.0) vs. 3.0 (2.0, 4.0), P < 0.01], and the sedative effect was increased, RASS score was significantly lower than that before administration [0 (0, 1.0) vs. 1.0 (1.0, 2.0), P < 0.01]. No patients in naporphine group were treated with sufentanil due to unsatisfactory analgesia. The average dosage was 0.11 (0.06, 0.14) μg·kg-1·h-1in the sufentanil group, the patient was satisfied with the analgesic effect until 5 hours after administration, and the CPOT score was significantly lower than that before administration [1.0 (1.0, 2.0) vs. 4.0 (3.0, 6.0), P < 0.01], and the sedative effect was significantly increased, RASS score was significantly lower than that before administration [0 (-1.0, 0) vs. 2.0 (1.0, 2.0), P < 0.01]. The scores of CPOT and RASS in the sufentanil group were significantly higher than those of the naporphine group before use, so the decrease in the CPOT and RASS scores of the two drugs was further analyzed, which indicated the decrease in CPOT score of naporphine group was significantly lower than that in sufentanil group from 3 hours on [1.0 (0, 2.0) vs. 2.0 (1.0, 3.0), P < 0.05], and the decrease in RASS score of naporphine group was significantly lower than that in sufentanil group from 1 hour on [0 (0, 1.0) vs. 1.0 (0, 2.0), P < 0.01]. It suggested that naporphine could achieve sustained and stable analgesic effect and avoid excessive sedation caused by sufentanil. Conclusions Naporphine had a sustained and stable analgesic effect on patients with mild and moderate ICU analgesia. The onset time of naporphine was equivalent to sufentanil, and it had a certain sedative effect and less influence on hemodynamics.

Design and application of bundle treatment plan in the early stage for severe human infection by avian influenza H7N9 / 中华危重病急救医学

Objective To design bundle treatment plan in the early stage for severe human infection by avian influenza H7N9, and explore its clinical efficacy and application value. Methods Fifteen patients with severe human infection by avian influenza H7N9 in Guizhou Province from December 29th, 2016 to June 7th, 2017 were enrolled. Patients admitted from March 6th, 2017 to June 7th, 2017 served as a prospective observation period (bundle treatment group), and those from December 29th, 2016 to March 5th, 2017 were selected as a historical control period (conventional treatment group). Conventional treatment group was given conventional treatment such as isolation, anti-virus, symptomatic treatment, and traditional Chinese medicine and so on. Bundle treatment group was given bundle treatment on the basis of conventional treatment, including isolation, anti-virus, respiratory support, restrictive fluid management, immunotherapy, inhibition of inflammation, antibiotic therapy, nutritional support, prevention of hospital acquired infection (HAP), individual sedation, continuous blood purification (CBP) for acute kidney injury (AKI) and severe acute respiratory distress syndrome (ARDS) patients, and intensive care. A cluster of bundle treatment team was set up to ensure that all measures carried out smoothly. The gender, age, onset to diagnosis time, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, oxygenation index (PaO2/FiO2) at admission, the length of intensive care unit (ICU) stay, total hospitalization time and prognosis of the two groups were observed. Correlation analysis between bundle therapy and prognosis was analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was drawn, and the clinical value of bundle treatment was analyzed. Results There was no significant difference in gender, age, onset to diagnosis time, APACHEⅡscore, PaO2/FiO2, the length of ICU stay, or total hospitalization time between bundle treatment group (n = 9) and conventional treatment group (n = 6), but the death patients in the bundle treatment group was significantly fewer than those in conventional treatment group (cases:2 vs. 5, χ2= 3.225, P = 0.041). Correlation analysis showed that there was a significant correlation between the mortality and whether received bundle treatment or not in patients who infected by avian influenza H7N9 (r = -0.875, P = 0.018). ROC curve analysis showed that the area under the ROC curve (AUC) of non-bundle treatment for predicting the death in patients with severe human infection by avian influenza H7N9 was 0.938, 95% confidence interval (95%CI) was 0.795-1.000, the sensitivity was 88.88%, and the specificity was 98.62%. Conclusions Early bundle therapy has a significant effect on severe human infection by avian influenza H7N9, which can improve the prognosis and reduce the mortality of patients. It is worthy for clinical application.