[Studies on newly recognized chronic sialadenitis].

Some kinds of chronic sialadenitis were recognized during the recent years. They have specific pathogenesis, clinical and histopathologic appearances, and require specific treatment. IgG4-related sialadenitis (IgG4-RS) is one of the immune-mediated diseases, characterized by tumefactive lesions. The incidence of IgG4-RS obviously increased during the past 30 years. The study on the potential relationship between occupational exposure to chemical substances and the incidence of IgG4-RS showed that subjects with occupational exposure to agents known to cause IgG4-RD had an increased risk for IgG4-RS. Surgical excision of involved SMG could not control the disease progression, which is not recommended for treatment of IgG4-RS. The combination of glucocorticoid and steroid-sparing agents is effective for treating IgG4-RS, and restores salivary gland function. Radioiodine induced sialadenitis (RAIS) is one of the common complications of postoperative adjuvant treatment of differentiated thyroid cancer by 131I. The incidence of the disease is related to radiation dosage. Clinically, the patients suffered from swelling and tenderness in the buccal or submandibular regions, especially during the mealtime. Imaging appearances are similar to those of chronic obstructive sialadenitis. Conservative managements, such as gland massage, sialagogues, are the mainstream methods in the treatment of RAIS. Sialendoscopy is feasible for RAIS, but not as effective as conventional obstructive sialadenitis (COS). Therefore the prevention of RAIS is crucial. Eosinophilic sialodochitis (ES) is a new type of chronic inflammatory disease of the salivary gland related to allergy. It has characteristics of swelling of multiple major salivary glands, strip-like gelatinous plugs discharged from the duct orifice of the gland, elevated level of serum IgE and eosinophils in peripheral blood, infiltration of eosinophils and IgE positive plasma cells in the tissues, allergic history, increased expression of allergy-related cytokines, such as IL-4, IL-5, IL-13, and eotaxin, which suggest allergic reactions as a potential pathogenesis of the disease. The clinical, laboratory, histological, and immunohistochemical characteristics of ES are significantly different from conventional obstructive sialadenitis (COS). Therefore, it is suitable to separate ES from COS. Conservative managements, such as self-maintenance therapy and anti- allergic modality are the choices of treatment for ES. Based on the results of our comprehensive studies a new classification of chronic sialadenitis is suggested.

[Application of magnetic sphincter augmentation for treating gastroesophageal reflux disease].

The lower esophageal sphincter incompetent is fundamental pathological abnormality of gastroesophageal reflux disease (GERD). Magnetic sphincter augmentation (MSA) is a magnetic bracelet, which designed to be placed surgically around the exterior surface of the distal esophagus. In the closed position, the highest attractive force between the magnetic beads would reinforce the lower esophageal sphincter to strengthen the antireflux barrier. Animal experiments and clinical trials have verified the safety and efficacy of MSA in GERD patients. For refractory GERD and GERD with huge hernia, MSA can also achieve acceptable clinical effect. Comparative researches appeared that there is no significantly difference in clinical effect between Nissen fundoplication and MSA. MSA could preserve the function of belching and vomiting postoperatively, and it can be implanted with the use of standard laparoscopic techniques. The long-term effect of MSA is satisfactory with less complications, which has been carried out in China since 2018. It can be predicted that MSA will play an important role in the treatment of GERD in the future.

[Preliminary results of Chinese magnetic sphincter augmentation in treating gastroesophageal reflux disease].

Objective: To examine the preliminary clinical efficacy of Chinese magnetic sphincter augmentation (MSA) in the treatment of gastroesophageal reflux disease (GERD). Methods: According to the enrollment criteria for the MSA developed by ShengJieKang Co. and Shanghai Chest Hospital (SS-MSA) clinical trial, a total of 19 GERD patients were treated with SS-MSA from August 2018 to January 2020 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University. The majority of registered cases were male patients with age of (32.2±7.3) years (range: 22 to 50 years), height of (170.7±6.2) cm (range: 160 to 179 cm) and weight of (65.2±10.3) kg (range: 47.5 to 90.0 kg). SS-MSA was implanted via laparoscopy. The major evaluation indexs of postoperative efficacy were the total time of acid exposure within 24 hours and the total number of reflux. Secondary efficacy indicators included: (1) evaluation of the average daily dose of proton pump inhibitor medications; (2) the score of GERD health related quality of life questionnaire (GERD-Q) before and after MSA implantation. Paired design t-test was used to evaluate the efficacy of the SS-MSA. Results: A total of 19 patients underwent SS-MSA surgery successfully. The history of the GERD were 19 (54) months (M(Q(R))). The operation time was 63 (22) minutes and the in-hospital stay was 3 (2) days. No obvious surgical complications occurred. Postoperative adverse events included 14 cases with mild to moderate dysphagia exited after surgery, gradually eased within 1 to 3 months, 1 case with the removal of the device after 1 month of severe swallowing difficulties, 1 case of diarrhea. No corrosion, perforation, displacement occurred. The GERD-Q score (11.0(4.5) vs. 6(1.0), t=4.274, P=0.013), 24-hour acid exposure time (6.2(4.8)% vs. 0.1(0.9)%, t=5.814, P=0.004), and Demeester score (23.72(16.20) vs. 0.96(3.10), t=6.678, P=0.003) were significantly decreased 1 year after surgery(n=5). Proton pump inhibitor reuse rates were 6/18, 5/15, 3/10, and 1/5 in 1, 3, 6 and 12 months after the operation, respectively. Conclusions: SS-MSA implantation is feasible and safe with short hospital stay and rare perioperative complications. The preliminary results is good after 1 year follow-up. It could be expected to be an ideal substitutive for future GERD treatment.

Moxibustion attenuates inflammatory response to chronic exhaustive exercise in rats.

Exercise is recognized as an activator to elicit an inflammatory response whilst moxibustion in traditional Chinese medicine has been previously found to modulate immune functioning. However, whether moxibustion can alleviate the inflammatory cytokines response to chronic exhaustive exercise remains unknown. In the present study, rats were randomly assigned to a sedentary control group (Sed), a sedentary moxibustion group (Sed + Moxa), and 2 trained groups- one submitted to a 3-week exhaustive swimming (Trained), and the other a trained moxibustion group (Trained + Moxa). We found that chronic exhaustive exercise significantly increased the serum levels of pro-inflammatory cytokines (IL-1ß, TNF-α, IFN-γ) and the IFN-γ/IL-4 ratio, and decreased the anti-inflammatory cytokines (IL-4, IL-10). Moxibustion treatment markedly reduced the serum levels of IL-1ß, IFN-γ and the IFN-γ/IL-4 ratio, while elevated the IL-4 and IL-10 productions in trained rats. However, TNF-α level was not significantly affected. Our results suggested that an excessive inflammatory response and a potential inflammatory damage may be involved during chronic exhaustive exercise. Moxibustion could attenuate the inflammatory impairment and have an anti-inflammatory effect. The beneficial effects of moxibustion might be mediated by reducing the pro-inflammatory cytokines, increasing the anti-inflammatory cytokines, and modulating the balance between pro- and anti-inflammatory cytokines.

Hypotensive response in rats and toxicological mechanisms induced by shuanghuanglian, an herbal extract mixture.

Shuanghuanglian (SHL), an extract mixture isolated from three medicinal herbs, has been used in China as an injection in traditional Chinese medicine to treat viral or bacterial infection. This study examined the hypotensive response in rats induced by SHL and its possible mechanisms. Mean arterial pressure (MAP) and electrocardiograms (ECGs) were studied after intravenous injection of histamine and SHL. Diphenhydramine, an H1 receptor antagonist, the compound 48/80, a promoter of histamine release, and cromolyn, a histamine release inhibitor, were also used to investigate the potential mechanisms of that response. In addition, the histamine level in plasma was measured after administration of SHL and compound 48/80. Both SHL and histamine led to a MAP reduction immediately but did not affect ECGs when initially administered in a similar manner, though this reduction was partially attenuated by diphenhydramine. Pretreatment blocked the rats' reaction to compound 48/80 but not to SHL. The plasma histamine level in rats was also elevated by SHL. SHL can induce severe hypotension through histamine release upon initial administration. In combination with the direct effects of its histaminelike substances on target tissue, SHL likely has the potential to cause an anaphylactoid reaction.

Triterpenoids and other compounds from Salvia roborowskii Maxim.

Two new triterpenoids, 2 alpha-hydroxy-3 beta-methoxyurs-12-en-28-oic acid and 3 alpha-hydroxy-2 alpha-methoxyurs-12-en-28-oic acid as well as 25 known compounds were isolated from the whole plant of Salvia roborowskii Maxim. Their structures were elucidated by means of spectral data and chemical transformation. This is the first report on the chemical constituents of this plant. The presence of eugenyl beta-D-glucopyranoside 22 in a plant of the genus Salvia is also reported for the first time.

[Determination of esculetin in semen Euphorbiae lathyridis L. by TLCS and comparison on the quality in different areas].

A TLC-densitometric method for the determination of oesculetin in Semen Euphorbia lathyridis (Euphorbiae lathyrdis) was established, and esculetin content in Semen Euphorbia lathyridis from three different producing areas (Zhengzhou, Chengdu and Chongqing) was determined. The method is accurate, sensitive and simple. The recovery is 98.63% and the coefficient of variation is 1.59% (n = 5). The esculetin average contents in the three samples are 0.3013%, 0.2046% and 0.2094% respectively.

Regeneration of re-covered bark in Eucommia ulmoides.

The girdled trunk of Eucommia ulmoides, sometimes could not regenerate a new bark due to ringed surface necrosis. But, if an extension of 10cm of the bark on each end of the necrotic part was removed in time and re-covered with new bark taken from another tree, the re-covered bark and the newly girdled part could heal together one week after. Opposite to the necrotic surface the loose part of the re-covered bark regenerated callus from the phloem ray cells. If the re-covered part was very close to the necrotic surface, no callus was regenerated. However, many scattered tracheid-like elements derived from phloem were found. And then groups of cells including several tracheid-like elements were discernible. There was a ring of meristematic cells around that group of cells. Finally these meristems gradually became normal and had usual activities of vascular cambium.