Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury: A Systematic Review and Meta-analysis.

OBJECTIVE: The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury. DESIGN: Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software. RESULTS: Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies. CONCLUSIONS: Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Spongiosum-combined glanuloplasty reduces glans complications after proximal hypospadias repair / 亚洲男科学杂志(英文版)

We aim to design a new glanuloplasty procedure combined with spongiosum to reduce the incidence of glans dehiscence and coronal fistula after proximal hypospadias repair. Patients who underwent urethroplasty by dorsal preputial island flap for proximal hypospadias between January 2014 and December 2016 were reviewed in this retrospective cohort study. Those who underwent spongiosum-combined glanuloplasty comprised the new-maneuver group, whereas those who underwent conventional glanuloplasty comprised the control group. The incidence of complications was then compared. In the new-maneuver group, dysplastic corpus spongiosum alongside lateral Buck's fascia (0.3-0.4 cm wide) on both sides of the urethral plate was separated from the proximal normal spongy tissue, joining into the glans wings to increase tissue volume and covering the neourethra in the glans penis. In the control group, the neourethra was covered with superficial fascia under the coronal sulcus. As a result, the new-maneuver and control groups comprised 47 and 28 patients, respectively. In the new-maneuver group, no glans dehiscence was detected; however, two (4.3%) patients had coronal fistula, two (4.3%) had urethral stricture, and four (8.5%) had diverticulum. In the control group, two (7.1%) patients had glans dehiscence, eight (28.6%) had coronal fistula, four (14.3%) had urethral stricture, one (3.6%) had diverticulum, and one (3.6%) had penile curvature recurrence. The new-maneuver group had less incidences of coronal fistula (P < 0.001), glans dehiscence (P = 0.033), and urethral stricture (P = 0.008) but had a higher incidence of diverticulum than the control group (P = 0.040). It clearly demonstrates that spongiosum-combined glanuloplasty can significantly reduce the incidences of coronal fistula and glans dehisce.

Effectiveness and Safety of Acupuncture for Migraine: An Overview of Systematic Reviews.

Background: Migraine is a common neurological disease, which burdens individuals and society all over the world. Acupuncture, an important method in Traditional Chinese Medicine, is widely used in clinical practice as a treatment for migraine. Several systematic reviews (SRs) have investigated the effectiveness and safety of acupuncture for migraine. Objective: To summarize and critically assess the quality of relevant SRs and present an objective and comprehensive evidence on the effectiveness and safety of acupuncture for migraine. Data Sources. MEDLINE, Embase, Cochrane Library, PROSPERO database, Chinese National Knowledge Infrastructure (CNKI), Chinese Biological Medicine (CBM), China Science and Technology Journal (SCTJ), and WanFang database (WF) were searched from inception to December 2019 and grey literatures were manually searched. Selection Criteria. SRs which meet the criteria were independently selected by 2 reviewers according to a predetermined protocol. Data Extraction. Characteristics of included SRs were independently extracted by 2 reviewers following a predefined data extraction form. Review Appraisal. The methodological quality, risk of bias, and reporting quality of included SRs were assessed, respectively, by a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, the Risk of Bias in Systematic reviews (ROBIS) tool, and the Preferred Reporting Item for Systematic Review and Meta-analysis-Acupuncture (PRISMA-A) statement. The quality of outcomes was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: A total of 15 SRs were included. All the SRs were published between 2011-2019. Based on AMSTAR 2, 14 out of 15 SRs were rated critically low quality and 1 was rated low quality. According to ROBIS tool, 9 SRs (60%) were low risk of bias. With the PRISMA-A checklist, we found 11 out of 15 SRs were found adequately reported over 70%. With the GRADE tool, we found high quality of evidence indicated that the effective rate of acupuncture was superior to western medicine in treatment of migraine. Besides, acupuncture reduced more headache days and the times of using painkiller and was more effective in reducing the frequency and degree of headache than western medicine and sham acupuncture. Limitations. There might be some missing information. The accuracy of the conclusions may be decreased reduced since we were unable to synthesis all the evidence. Conclusions: Based on high quality of evidence, we concluded that acupuncture may be an effective and safe therapy for migraine. However, the quality of SRs in acupuncture for migraine still needs more improvement.

Continuous splenogonadal fusion: a case report and review of literature / 上海交通大学学报（医学版）

A 4-year-old boy with a painless mass for 3 years in the left scrotum was admitted to the hospital. Three testicle-like substances could be palpable one by one from groin to scrotum on the left side during physical examination. The upper and middle parts were slightly hard, while the lower part was slightly soft. The splenogonadal fusion (SGF) in the left side was found by laparoscopy after admission. Accessory splenectomy was performed with preservation of the left testicle. Postoperative follow-up was 18 months. The testicles were well developed without atrophy, and abdominal B-ultrasound showed no abnormality in liver, gallbladder and spleen. SGF was a rare congenital abnormality, which was difficult to diagnose preoperatively. During the operation, if the SGF was found, accessory splenectomy with testicle-sparing should be performed. Laparoscope can be used as an effective diagnosis and treatment method to improve the understanding of SGF, and avoid unnecessary orchiectomy.

Theta burst stimulation for upper limb motor dysfunction in patients with stroke: A protocol of systematic review and meta-analysis.

BACKGROUND: Upper limb dysfunction is one of common sequelae of stroke which limits daily activities and decreases quality of life of patients, as well as increasing caregiving burden on families. Theta burst stimulation (TBS) is considered to be a beneficial therapy for post-stroke patients with upper limb motor dysfunction, but there is a lack of a high quality evidence. We aim to investigate the effectiveness and safety of TBS for upper limb motor dysfunction in patients with stroke. METHODS: The following databases will be searched: PubMed, EMBASE, The Cochrane Library, Web of Science, China Biology Medicine (CBM), China National Knowledge infrastructure (CNKI), Technology Periodical Database (VIP) and WanFang Data from the inception to October 2019. All relevant randomized controlled trials (RCTs) using TBS to treat poststroke patients with upper limb motor dysfunction will be included. The primary outcome is Upper Limb Fugl-Meyer Assessment (UL-FMA). Secondary outcomes will include Action Research Arm Test (ARAT), Box and Block Test (BBT), Wolf Motor Function Test (WMFT), Motor Assessment Scale (MAS), Nine Hole Peg Test (NHPT), Grip strength and other scales evaluating the upper limb motor function. Adverse effects will also be evaluated. Two reviewers will screen studies, extract data and assess the risk of bias of included studies independently. Data analysis will be conducted using Review Manager software (RevMan, version 5.3.5) and R software (version 3.6.1). RESULTS: Our SR will be conducted according to AMSTAR 2.0 and reported in compliance with PRISMA. The findings of this SR will be disseminated through peer-reviewed publications or conference presentations. CONCLUSION: Our study will provide evidence for the effectiveness and safety of theta burst stimulation for upper limb motor dysfunction in patients with stroke. ETHICS AND DISSEMINATION: This systematic review (SR) does not require formal ethical approval since no privacy health information will be included. The findings of this SR will be disseminated through peer-reviewed publications or conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019142462.

Regulatory effect of icariin and oleanolic acid combined with dexamethasone on JAKs/STATs signaling pathway in hormone-resistant CEM-C1 cells / 医学研究生学报

Objective The mechanisms of epimedium and Ligustrum Lucidum with glucocorticoid (GC) acting on asthma are closely related to the regulation of the JAKs / STATs pathway associated with the Th1/Th2 balance in the lung tissue of the asthmatic rats. This study aimed to investigate the synergistic effect of icariin and oleanolic acid with dexamethasone on the protein expressions of JAKs/STATs in GC-sensitive CEM-C7 and GC-resistant CEM-C1 cells.Methods We divided CEM-C7 and CEM-C1 cells into groups A (complete culture medium control), B (dexamethasone at 10-6mol/L), C (icarrin at 100 mg/mL), D (oleanolic acid at 100 mg/mL), E (icarrin+oleanolic acid both at 50 mg/mL), and F (icariin+oleanolic acid+dexamethasone at 50 mg/mL, 50 mg/mL and 10-6 mol/L, respectively), and treated them with corresponding agents for 24 hours. Then, we determined the protein expressions of JAKs (JAK1 and JAK2) and STATs (STAT1, STAT3, STAT5, and STAT6) in the CEM-C7 and CEM-C1 cells of different groups by Western blot.Results The protein expressions of JAK1 and JAK2 in the CEM-C1 cells were 0.22±0.01 and 0.23±0.01 in group A, 0.24±0.01 and 0.24±0.01 in group B, 0.23±0.01 and 0.22±0.01 in group C, 0.24±0.01 and 0.23±0.01 in group D, 0.22±0.01 and 0.21±0.01 in group E, and 0.18±0.01 and 0.19±0.01 in group F, both significantly lower in groups E and F than in B (P<0.01), and in groups C, D and F than in E (P<0.01). The expressions of STAT1 and STAT3 proteins were 0.23±0.01 and 0.23±0.01 in group A, 0.23±0.01 and 0.22±0.01 in group B, 0.23±0.01 and 0.22±0.01 in group C, 0.23±0.01 and 0.23±0.01 in group D, 0.18±0.01 and 0.20±0.02 in group E, and 0.17±0.01 and 0.16±0.01 in group F, both remarkably lower in groups E and F than in B (P<0.01), and that of STAT3 even lower in F than in E (P<0.01). The expressions of STAT5 and STAT6 were 0.24±0.01 and 0.24±0.01 in group A, 0.23±0.01 and 0.23±0.02 in group B, 0.23±0.01 and 0.24±0.01 in group C, 0.23±0.01 and 0.24±0.01 in group D, 0.19±0.01 and 0.19±0.01 in group E, and 0.16±0.01 and 0.20±0.02 in group F, both markedly lower in groups E and F than in B (P<0.01), and even lower in F than in E (P<0.01). The protein expressions of JAK1 and JAK2 in the CEM-C7 cells were 0.24±0.01 and 0.22±0.02 in group A, 0.12±0.01 and 0.49±0.01 in group B, 0.23±0.01 and 0.27±0.01 in group C, 0.25±0.01 and 0.25±0.02 in group D, 0.27±0.01 and 0.23±0.01 in group E, and 0.20±0.01 and 0.32±0.01 in group F, the former increased while the latter decreased significantly in groups B, C, D, E and F as compared with group A (P<0.01), the former even lower and the latter even higher in groups C and F than in E (P<0.01). The expressions of STAT1 and STAT3 were 0.23±0.01 and 0.23±0.01 in group A, 0.10±0.01 and 0.11±0.02 in group B, 0.27±0.01 and 0.26±0.01 in group C, 0.27±0.01 and 0.27±0.01 in group D, 0.28±0.01 and 0.27±0.01 in group E, and 0.21±0.01 and 0.23±0.02 in group F, both remarkably higher in groups C, D, E and F than in B (P<0.01), though lower in F than in E (P<0.01). The expressions of STAT5 and STAT6 were 0.24±0.01 and 0.24±0.01 in group A, 0.10±0.01 and 0.11±0.02 in group B, 0.23±0.01 and 0.23±0.02 in group C, 0.23±0.01 and 0.23±0.01 in group D, 0.24±0.01 and 0.24±0.01 in group E, and 0.20±0.01 and 0.21±0.05 in group F, both significantly upregulated in groups C, D, E and F as compared with B (P<0.01), though lower in F than in E (P<0.05).Conclusion In case of hormone resistance, icariin and oleanolic acid combined with dexamethasone may regulate the JAKs/STATs signaling pathway and improve the sensitivity to hormone action.

Clinical Analysis of Refractory Primary Central Nervouse System Lymphoma Treated with High-Dose MTX-Based Chemotherapy and Haploidentical Hematopoietic Stem Cell Infusion / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and safety of high-dose methotrexate-based chemotherapy combined with granulocyte-colony stimulating factor (G-CSF)-mobilized family related haploidentical donor peripheral blood hematopoietic stem cell (G-PBHSC) infusion for the treatment of patients with refractory primary central nervouse system lymphoma (PCNSL).</p><p><b>METHODS</b>Three patients with refractory PCNSL were treated in Department of Hematology of the General Hospital of the PLA's Rocket Force from March 2014 to September 2015. The sex ratio of male to female was 1:2 and the median age was 54(48-66)years old. All patients received programmed infusions of G-PBHSC after high-dose methotrexate-based chemotherapy without prophylaxis for graft-versus-host disease (GVHD).</p><p><b>RESULTS</b>Three patients had received initial chemotherapy or radiotherapy after diagnosis, one patient achieved complete remission (CR) after 3 courses of treatment and remained in CR until the end of follow-up, 2 cases achieved partial remission (PR) and the progression-free survival (PFS) time was 10 and 7 months, respectively. The patients generally well-tolerated this therapy. The main adverse effects of patients were neutropenia, thrombocytopenia and infection related with chemotherapy after each course of treatment, the median recovery times of neutrophils and platelets were 11 and 12.5 days, respectively after of programmed infusions of G-PBHSC. No GVHD was observed in any of the patients during treatment.</p><p><b>CONCLUSION</b>The combination of high-dose methotrexate-based chemotherapy with programmed haploidentical G-PBHSC infusion is a potential treatment alternative for refractory PCNSL patients.</p>

Shikani Optical Stylet versus Macintosh Laryngoscope for Intubation in Patients Undergoing Surgery for Cervical Spondylosis: A Randomized Controlled Trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Airway management is critical in patients with cervical spondylosis, a population with a high incidence of difficult airway. Intubation with Shikani Optical Stylet (SOS) has become increasingly popular in difficult airway. We compared the effects of intubation with SOS versus Macintosh laryngoscope (MLS) in patients undergoing surgery for cervical spondylosis.</p><p><b>METHODS</b>A total of 270 patients scheduled for elective surgery for cervical spondylosis of spinal cord and nerve root type from August 2012 to January 2016 were enrolled and randomly allocated to the MLS or SOS group by random numbers. Patients were evaluated for difficult airway preoperatively, and Cormack-Lehane laryngoscopy classification was determined during anesthesia induction. Difficult airway was defined as Cormack-Lehane Grades III-IV. Patients were intubated with the randomly assigned intubation device. The success rate, intubation time, required assistance, immediate complications, and postoperative complaints were recorded. Categorical variables were analyzed by Chi-square test, and continuous variables were analyzed by independent samples t-test or rank sum test.</p><p><b>RESULTS</b>The success rate of intubation among normal airways was 100% in both groups. In patients with difficult airway, the success rates in the MLS and SOS groups were 84.2% and 94.1%, respectively (P = 0.605). Intubation with SOS took longer compared with MLS (normal airway: 25.1 ± 5.8 s vs. 24.5 ± 5.7 s, P = 0.426; difficult airway: 38.5 ± 8.5 s vs. 36.1 ± 8.2 s, P = 0.389). Intubation with SOS required less assistance in patients with difficult airway (5.9% vs. 100%, P< 0.001). The frequency of postoperative sore throat was lower in SOS group versus MLS group in patients with normal airway (22.0% vs. 34.5%, P = 0.034).</p><p><b>CONCLUSIONS</b>SOS is a safe and effective airway management device in patients undergoing surgery for cervical spondylosis. Compared with MLS, SOS appears clinically beneficial for intubation, especially in patients with difficult airway.</p><p><b>TRIAL REGISTRATION</b>Chinese Clinical Trial Registry, ChiCTR-IOR-16007821; http://www.chictr.org.cn/showproj.aspx?proj=13203.</p>

High-frequency ultrasonography for diagnosis and differential diagnosis of acute scrotum in children / 中华男科学杂志

<p><b>Objective</b>To analyze the high-frequency ultrasound image features of acute scrotum in children and explore the value of high-frequency ultrasonography in the diagnosis and differential diagnosis of the disease.</p><p><b>METHODS</b>This retrospective study included 256 children aged 2 days to 14 years undergoing color Doppler ultrasonography at 2 hours to 3 days after onset of acute scrotum. We analyzed the morphology, internal echo and blood supply of the testis in comparison with the clinical and pathological results.</p><p><b>RESULTS</b>Among the 256 cases, acute testicular torsion was found in 23, of which 16 were treated by complete resection the necrotic testis and the other 7 by surgical reduction of testicular torsion. Ultrasonographically, the involved testes presented different degrees of increase or decrease in volume, with uneven internal echoes, irregular hypoechoic flakes, and testicular hydrocele. Color Doppler flow imaging (CDFI) showed significant blood flow signals around the diseased testes but none within them. Acute testicular appendix torsion was found in 116 cases, in which ultrasonography manifested nodules with round or oval abnormal echoes between the upper pole of the testis and caput epididymidis, first hypoechoic and then gradually increased, heterogeneous internally. CDFI revealed enlarged epididymides and enriched testicular blood flow but no blood flow signals in the nodules. The 103 cases of acute epididymitis were ultrasonographically characterized by varied degrees of swelling of the involved epididymis with uneven internal echoes and rich blood flow signals on CDFI. Six of the cases were diagnosed as acute orchitis, with the ultrasonographic features of testicular swelling and low but uniform internal echoes, with rich blood flow signals on CDFI. Incarcerated inguinal hernia was confirmed in 15 cases, in which ultrasonography revealed intrusion of the hernia into the obviously enlarged scrotal sac with the mesentery and intestine in it, and blood flow visible on CDFI. Acute scrotal wall hematoma and edema was found in 8 cases, with the ultrasonographic characteristics of scrotal wall thickening, with visible blood flow signals on CDFI.</p><p><b>CONCLUSIONS</b>High-frequency ultrasonography has a high sensitivity and specificity for acute scrotum in children, which can be applied as the first-choice clinical imaging modality and provide reliable evidence for the diagnosis and differential diagnosis of the disease.</p>

Preformulation study on anti-smallpox drug tecovirimat / 国际药学研究杂志

Objective To study the preformulation properties of tecovirimat for formulation design. Methods The appearance, crystal structure, solubility and permeability of the drug were investigated. The UV method was established to determine the content of tecovirimat in vitro. The solubilization experiment was also conducted. Results Tecovirimat is white and odorless powder with crystalline hydrate structure and low water-solubility with high permeability. The morphology of tecovirimat is six-prismatic-shape. The linearity range of established UV method was 4.14-24.83 µg/ml(r=0.9996). The 1:1 soluble complex was formed with tecovirimat and hydroxypropyl-β-cyclodextrin. Conclusion Tecovirimat is poorly water-soluble drug with high permeability and the established method could be used to determine the content of the drug. Hydroxypropyl-β-cyclodextrin could be used for the solubilization of tecovirimat.

C825T polymorphism of G protein beta3 subunit gene and Uygur Hilit type of essential hypertension: a correlation study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the association between C825T polymorphism of G protein beta3 subunit (GNB3) gene and different Hilit types of essential hypertension (EH) in the Uygur nationality of Xinjiang.</p><p><b>METHODS</b>According to Uygur medical theories, EH patients (as the EH group) and non-EH patients (as the control group) were assigned to four Hilit groups. The C825T polymorphism of GNB3 was detected in 161 EH patients and 379 non-EH subjects of different Hilit types by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) to explore the difference of the genotypes and allelic frequencies and hypertension.</p><p><b>RESULTS</b>(1) In Xinjiang Uygur population, the distribution frequencies of GNB3 C825T polymorphism were in accordance with Hardy-Weinberg (chi2 = 0.871, P = 0.647). (2) There was no statistical difference in the distribution frequencies of three genotypes and two alleles of GNB3 between the EH group and the control group (P > 0.05). (3) There was statistical difference in distribution frequencies of three genotypes between the abnormal Sapra and non-abnormal Sapra group (the sum of abnormal Sewda, abnormal Kan, and abnormal Balhem) (chi2 = 6.905, P = 0.032), especially between the abnormal Sapra and abnormal Balhem groups (chi2 = 10.404, P = 0.006), but there was no statistical difference in distribution frequencies of alleles between the two groups (P > 0.05). (4) In 161 EH patients, there was statistical difference in the distribution frequencies of three genotypes and two alleles between the abnormal Sapra and non-abnormal Sapra group (chi2 = 9.034, P = 0.011; chi2 = 4.701, P = 0.03).</p><p><b>CONCLUSIONS</b>Both TT genotype and T allele of GNB3 C825T polymorphism might not be associated with EH patients in Xinjiang Uygur populations. However, they were correlated with hypertension patients of non-abnormal Sapra, indicating the pathogeneses of EH with different Hilit types might be different.</p>

Differentially expressed microRNAs at different stages of atherosclerosis in ApoE-deficient mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Atherosclerosis is the primary cause of cardiovascular disease, carotid artery disease, and peripheral vascular disease. However, it is hard to obtain human arterial tissue at different stages of atherosclerosis for a systematic study. The ApoE-deficient (ApoE(-/-)) mice predictably develop spontaneous atherosclerotic plaques with numerous features similar to the human lesions and contain nearly the entire spectrum of lesions observed during atherogenesis in humans. MicroRNA expression profiles at different stages of atherosclerosis in ApoE-deficient mice were screened to find out the differentially expressed microRNAs.</p><p><b>METHODS</b>ApoE-deficient mice were euthanized at 4, 8, and 20 weeks of age and divided into three groups according to the three time points, including groups A4 (fed a Western-type diet for 0 week), A8 (fed a Western-type diet for 4 weeks), and A20 (fed a Western-type diet for 16 weeks). Atherosclerotic lesions were analyzed. Fifteen aortas were collected and combined into three pools (five aortas in one pool) in each group. MicroRNA microarray analysis was replicated thrice in each group. The threshold of fold change ≥ 2.0 was used to screen up or down-regulated microRNAs. Differentially expressed microRNAs were subsequently verified with quantitative real-time polymerase chain reaction. Those increasingly up or down-regulated microRNAs during the progression of atherosclerosis were selected.</p><p><b>RESULTS</b>Atherosclerotic lesions first appeared in the aortic arch in group A8. Severe atherosclerotic lesions were observed in group A20. In group A8, seven MicroRNAs were up-regulated while two were down-regulated. In group A20, 15 microRNAs were up-regulated while two were down-regulated. miR-34a-5p and miR-497-5p were increasingly up-regulated, while miR-434-3p was progressively down-regulated when atherosclerosis progressed.</p><p><b>CONCLUSIONS</b>In this study, we described that microRNAs are differentially expressed at different stages of atherosclerosis in ApoE-deficient mice. Those increasingly up or down-regulated microRNAs during the progression of atherosclerosis may play an important role in the pathogenesis of atherosclerosis and provide us opportunities for investigating atherosclerosis from early to advanced stages.</p>

Ultrasound-guided compression repair for iatrogenic femoral artery pseudoaneurysm / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate relative factors affecting the efficiency of ultrasound-guided compression repair in iatrogenic femoral artery pseudoaneurysm.</p><p><b>METHODS</b>Ultrasound-guided manual compression was performed in 42 patients of iatrogenic femoral artery pseudoaneurysm from June 2004 to June 2010. There were 28 male and 14 female patients, with a mean age of (52 ± 5) years. These patients were presented with femoral artery pseudoaneurysm after catheterisation procedure by percutaneous femoral artery puncture and confirmed by color doppler flow image. Ultrasound-guided manual persistent compression with probe was performed at the puncture site between femoral artery and pseudoaneurysm, until completely thrombosis of pseudoaneurysm, whereas the pseudoaneurysm failed to complete closure required surgical repair.</p><p><b>RESULTS</b>Out of 42 patients, 34 patients (81.0%) were successfully treated by compression resulted in completely thrombosis. There were 8 (19.0%) failures conversion to surgery. Factors associated with success were size of pseudoaneurysm (< 25 mm, 25 - 40 mm, > 40 mm; χ(2) = 13.956, P = 0.001), anti-coagulation status (χ(2) = 5.578, P = 0.010), depth of artery break (< 50 mm, 50 - 80 mm, > 80 mm; χ(2) = 14.055, P = 0.001), pseudoaneurysm communicated with common femoral artery, superficial femoral artery and profunda femoral artery (χ(2) = 8.968, P = 0.011), as well as days to presented with pseudoaneurysm (< 3 d, ≥ 3 d; χ(2) = 5.733, P = 0.012). In multivariate Logistic regression analysis, success by compression was associated with size of pseudoaneurysm (WALD = 5.34, P = 0.021) and with depth of artery break (WALD = 4.84, P = 0.028).</p><p><b>CONCLUSION</b>The ultrasound-guided compression repair of iatrogenic femoral artery pseudoaneurysm is safe, convenient, inexpensive and reliable treatment.</p>

Short-term spontaneous fluctuation of viral load in patients with chronic hepatitis B / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the short-term spontaneous fluctuation of viral load in patients with chronic hepatitis B (CHB) and explore the related factors in treatment naive CHB patients during immune clearance phase.</p><p><b>METHODS</b>A total of 123 treatment naive HBeAg-positive CHB patients with ALT>2 × ULN were enrolled in this study. Paired serum samples were obtained at the first and second visits with an interval of less than 4 weeks. The levels of quantitative HBV DNA (Roche COBAS), quantitative HBsAg, ALT and AST were analyzed. Liver biopsy specimen were collected within 4 weeks and evaluated using Knodell and Ishak histological scoring system.</p><p><b>RESULTS</b>Of the 123 patients, 93 (75.6%) and 30 (24.4%) had HBV DNA fluctuation ≤ 0.5 Log IU/ml and >0.5 Log IU/ml, respectively. Binary logistic multivariate regression analysis identified Knodell necroinflammation score and HBV DNA level as the factors related to HBV DNA fluctuation. Patients with Knodell necorinflammation score ≥ 10 or HBV DNA<7 Log IU/ml had significantly higher rates of HBV DNA fluctuation>0.5 Log IU/ml (50.0% vs 18.3%, P=0.042; 42.9% vs 20.6%, P=0.030).</p><p><b>CONCLUSION</b>Treatment naive CHB patients in immune clearance phase show short-term spontaneous fluctuation of HBV DNA, and nearly 25% of the patients have HBV DNA fluctuation >0.5 Log IU/ml. Such fluctuation is related to liver inflammation and quantity of HBV DNA.</p>

Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The primary objective of this multicenter post-market study was to compare the cosmetic outcome of triclosan-coated VICRYL Plus sutures with Chinese silk sutures for skin closure of modified radical mastectomy. A secondary objective was to assess the incidence of surgical site infection (SSI).</p><p><b>METHODS</b>Patients undergoing modified radical mastectomy were randomly assigned to coated VICRYL Plus antibacterial (Polyglactin 910) suture or Chinese silk suture. Cosmetic outcomes were evaluated postoperatively at days 12 (± 2) and 30 (± 5), and the evidence of SSI was assessed at days 3, 5, 7, 12 (± 2), 30 (± 5), and 90 (± 7). Cosmetic outcomes were independently assessed via visual analogue scale (VAS) score evaluations of blinded incision photographs (primary endpoint) and surgeon-assessed modified Hollander Scale (mHCS) scores (secondary endpoint). SSI assessments used both CDC criteria and ASEPSIS scores.</p><p><b>RESULTS</b>Six Chinese hospitals randomized 101 women undergoing modified radical mastectomy to closure with coated VICRYL Plus suture (n = 51) or Chinese silk suture (n = 50). Mean VAS cosmetic outcome scores for antibacterial suture (67.2) were better than for Chinese silk (45.4) at day 30 (P < 0.0001)). Mean mHCS cosmetic outcome total scores, were also higher for antibacterial suture (5.7) than for Chinese silk (5.0) at day 30 (P = 0.002).</p><p><b>CONCLUSIONS</b>Patients using coated VICRYL Plus suture had significantly better cosmetic outcomes than those with Chinese silk sutures. Patients using coated VICRYL Plus suture had a lower SSI incidence compared to the Chinese silk sutures, although the difference did not reach statistical significance.</p>

Clinical analysis of vascular anomalies: a hospital-based retrospective study of 592 patients in southeast China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Vascular anomalies are common and multidisciplinary involved diseases. The greatest impediment to their treatment in the past was their confusing terminology and clinical heterogeneities. This hospital-based retrospective study assessed some clinical characteristics, diagnosis, therapies and outcomes of patients with vascular anomalies in southeast China.</p><p><b>METHODS</b>A total of 592 vascular anomalies patients (patients with intracranial tissues or viscera involved were excluded), admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2006 to September 2009, were enrolled in the study. Data for clinical characteristics, diagnosis, therapies and outcomes were collected and analyzed.</p><p><b>RESULTS</b>Of the 592 patients, the male:female ratios in the vascular tumor group (n = 187) and the vascular malformation group (n = 405) were 1:1.49 and 1:1.06 respectively, with no significant difference between them. The mean onset age of the vascular tumor group was significantly younger than that of the vascular malformation group (p < 0.001). The head and neck were the most commonly (31.4%) involved areas in vascular anomalies. A total of 23.8% of the patients with vascular anomalies had definite symptoms caused by the vascular lesions. In the vascular tumor group, 94.1% of them were infantile hemangiomas. Venous malformation was the most common (41.0%) subtype of vascular malformations. Surgical therapy was undertaken in 94.2% of the patients with vascular anomalies. Of the 519 patients available for the 16 - 58 month follow-up, 322 patients (62.0%) were cured, 108 patients (20.8%) were markedly improved, 57 patients (11.0%) were partially improved, and 32 patients (6.2%) were uncured.</p><p><b>CONCLUSIONS</b>Vascular anomalies are clinically heterogeneous. While the outcome is generally favorable, further effort should be made to determine the appropriate terminology and management.</p>

Potential causes and optimal treatment strategy of recurrent venous ulceration in lower limb / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the potential causes and the optimal treatments of recurrent venous ulceration of lower limbs after initial operation.</p><p><b>METHODS</b>Data of patients admitted between January 2000 and June 2010 for recurrent ulceration in lower limbs after previous operation were retrospectively analyzed. Altogether 81 limbs in 73 patients were recruited. There were 55 male patients (60 limbs) and 18 female patients (21 limbs). The average age was 52.6 years (ranging from 31 to 73 years). All the patients had received at least one surgery procedures before recurrence. The average time between ulceration recurrence and the last operation was 10.6 months (ranging from 5 to 37 months). Average diameter of ulcers was 3.7 cm (ranging from 1.3 to 6.5 cm). Color duplex sonography before re-treatment revealed incompetent calf perforators in 57 limbs (70.4%), primary deep vein insufficiency in 38 limbs (46.9%), post-DVT syndrome in 16 limbs (19.8%), reflux of accessory saphenous veins in 11 limbs (13.6%) and residual/re-opened great saphenous vein in 8 limbs (9.9%). Managements including stripping of great saphenous vein, ligation around the ulcer, percutanous ligation of varicose veins, valvoplasty, and adjuvant compressive therapy were adopted according to different venous abnormality.</p><p><b>RESULTS</b>All the patients were followed. All the ulcers healed and hemodynamic indexes were greatly improved 6 months after re-operation. Only 3 limbs (3.7%) suffered again from recurrence 1 year after re-operation.</p><p><b>CONCLUSIONS</b>Incompetent perforators in calf, primary or secondary deep vein insufficiency and incorrectly treated saphenous veins are main causes for recurrent venous ulceration in our series. Management of residual vein abnormalities can still achieve satisfying clinical outcome.</p>

Endovascular repair of abdominal aortic aneurysm: a clinical report of 81 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), and to compare the prognosis between patients of different ages.</p><p><b>METHODS</b>The hospitalization and follow-up data of 81 AAA patients treated by EVAR from May 2005 to May 2011 were retrospectively analyzed. All the patients were divided into advanced age group (age ≥ 75 years, 24 cases) and relatively young group (age < 75 years, 57 cases). General conditions, comorbidity, procedure, in-hospital complications, and follow-up were compared between these two groups.</p><p><b>RESULTS</b>All covered stents were successfully deployed, a technical success rate of 91.4% (74/81) was achieved. There was no intraoperative death. In-hospital mortality was 1.2% (1/81). The follow-up rate was 91.4% (74/81), with a mean follow-up of 47.5 months. Twelve deaths were recorded during follow-up, 1, 2, 3, 4, and 5-year survival rates were 98.6%, 92.2%, 80.8%, 58.7%, and 44.1%, respectively. When compared with relatively young group, the advanced age group had a lower rate of abdominal pain as the major symptom, but a higher rates of renal diseases and coronary artery diseases. Furthermore, the advanced age group had a longer stay in intensive care unit and higher morbidity of endoleaks, and also tended to have increased rates of pulmonary infection and access site hematoma, while the other parameters were similar between the two groups.</p><p><b>CONCLUSIONS</b>EVAR of AAA is less invasive, safe, and effective during short to mid-tern follow-up. The patients of advanced age suffer from higher rates of some complications, thus careful perioperative preparation and intensive monitor are mandatory for preventing or treating potential complications and improving prognosis for these patients.</p>

Evaluation of the ELISA and the enhanced chemiluminescence immunoassay in use to determine the serum markers for liver fibrosis / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To evaluate the detection method of ELISA and Enhanced Chemiluminescence Immunoassay (ECLIA) in use to determine serum hyaluronate acid (HA), laminin (LN), type IV collagen (IV-C) and type III procollagen (PC III).</p><p><b>METHODS</b>253 patients with chronic hepatitis B were determined the four liver fibrosis serum markers with both the ECLIA and ELISA, and then compared with pathology results separately.</p><p><b>RESULTS</b>Both the detection results of ELISA and ECLIA can reflect that the patient's liver fibrosis from hepatitis to liver cirrhosis aggravated gradually. Compared with ELISA, the results of ECLIA and pathology have a better correlation.</p><p><b>CONCLUSIONS</b>The detection of four liver fibrosis serum markers by ECLIA could indicate the better the response of the state of live fibrosis.</p>

Etiological analysis and treatment of the complications of hybrid procedure in the treatment of aortic arch diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the reasons of complications after hybrid procedure in the treatment of aortic arch diseases.</p><p><b>METHODS</b>Data from 34 consecutive patients (28 male and 6 female) of aortic arch diseases treated with hybrid procedure between January 2001 and December 2008 was analyzed retrospectively. The mean age of the patients was 56.7 years (ranged from 34 to 75 years). Of the 34 patients, 27 were aortic dissections (21 cases of Stanford type A dissections and 6 cases of Stanford type B dissections) and 7 were aortic arch aneurysms. Hybrid procedure included ascending aorta (AA)-innominate artery-left common carotid artery (LCCA) bypass (n = 3), AA-LCCA-left subclavian artery (LSA) bypass (n = 2), AA-LCCA bypass and coronary artery bypass (n = 1), LCCA-right common carotid artery (RCCA) bypass (n = 13), RCCA-LCCA and LCCA-LSA bypass (n = 3), LSA-LCCA-RCCA bypass (n = 2) and LCCA-LSA bypass (n = 9). All the patients received single stage (n = 26) or staged (n = 8) endovascular repairs.</p><p><b>RESULTS</b>The complications occurred in 32.4% (11/34), with 11.8% (4/34) of all patients having lethal complications. The complications included 1 case of rupture of aortic dissection (2.9%), 2 cases of stroke (5.9%), 2 cases of stomal leak and pseudoaneurysm (5.9%), 1 case of myocardial infarct (2.9%), 1 case of pulmonary embolism (2.9%), 1 case of neck hematoma (2.9%) and 3 cases of endoleak (8.8%). In the period of follow-up (6 to 50 months), all patients were alive except for 4 perioperative deaths.</p><p><b>CONCLUSIONS</b>Complication rate of hybrid procedure in the treatment of aortic arch diseases is higher than that of simple endovascular repair of descending aortic diseases. Reducing the lethal complications is the key to disseminate this technique.</p>