Effects of sand therapy on hemodynamics in the femoral artery bifurcation at different degrees of stenosis / 中国组织工程研究

BACKGROUND: Sand therapy has been shown to exhibit a positive effect on reducing femoral atherosclerosis and inhibiting thrombosis. OBJECTIVE: To investigate the effects of sand therapy on hemodynamic parameters of different stenosis models of femoral bifurcation through comparing the hemodynamic parameters and wall shear stress in four stenosis models before and after sand therapy. METHODS: The study protocol was performed in strict accordance with the relevant ethical requirements of School of Mechanical Engineering of Xinjiang University. Each participant provided written informed consent. Medical software Mimics10.01, reverse engineering software Geomagic Studio 2012 and three-dimensional CAD software UG8.5 were used to separate and optimize the CT data of a subject’s lower extremities and the geometric model of the femoral artery bifurcation was obtained. According to the classification criteria of vascular stenosis caused by femoral atherosclerotic plaque in the lower extremity, the degree of plaque stenosis on the side wall of the femoral bifurcation tube was set as 0% (normal), 15% (normal), 30% (mild) and 50% (moderate). Computational fluid dynamics method was used for numerical simulation. The Laminar flow model was selected for blood flow before sand therapy, and the standard turbulence model κ-ε was selected for blood flow after sand therapy. Blood flow velocity and wall shear stress were analyzed before and after sand therapy. RESULTS AND CONCLUSION: The maximum blood flow velocity after sand therapy was 0.35-0.45 m/s higher than that before sand therapy. After sand therapy, the wall shear stress at the stenosis was increased by 5-11 Pa compared with that before sand therapy, and the wall shear stress at 50% vascular stenosis rate model reached 41 Pa. These results suggest that the trend of atherosclerotic plaque enlargement is decreased after sand therapy, but patients with 50% (moderate) vascular stenosis have the risk of plaque rupture.

Effects of Sand Therapy on Hemodynamics of Human Flexural Femoral Arteries / 医用生物力学

Objective To study the effect of sand therapy on the hemodynamics of flexural femoral artery, and further reveal the therapeutic mechanism of sand therapy from the perspective of hemodynamics. Methods The three-dimensional finite element model of the curved femoral artery was established based on CT images of human aorta, and the data of heart rate, peak blood flow velocity and inner diameter of femoral artery measured by the experiment were used as initial conditions and boundary conditions to carry out finite element numerical simulation. The blood flow velocity, pressure and wall shear stress before and after sand therapy were analyzed and compared under fluid-solid coupling condition. Results Compared with treatment before sand therapy, the longitudinal velocity of the flexural segment of blood vessel increased significantly, with an increase of 22.76%. The secondary reflux velocity decreased significantly, with a relative decrease of 18.26%. The wall shear stress decreased by 2.01% after sand therapy. Conclusions Sand therapy had a significant effect on blood fluidity, by improving blood flow of femoral arteries, and preventing deposition of arterial platelets. The transverse flow phenomenon was obviously weakened after sand therapy, which could avoid the deposition of substances in blood and had a positive effect on the prevention of atherosclerosis, thrombosis and other vascular diseases.

Effects of Sand Therapy on Hemodynamics of Human Flexural Femoral Arteries / 医用生物力学

Objective To study the effect of sand therapy on the hemodynamics of flexural femoral artery, and further reveal the therapeutic mechanism of sand therapy from the perspective of hemodynamics. Methods The three-dimensional finite element model of the curved femoral artery was established based on CT images of human aorta, and the data of heart rate, peak blood flow velocity and inner diameter of femoral artery measured by the experiment were used as initial conditions and boundary conditions to carry out finite element numerical simulation. The blood flow velocity, pressure and wall shear stress before and after sand therapy were analyzed and compared under fluid-solid coupling condition. Results Compared with treatment before sand therapy, the longitudinal velocity of the flexural segment of blood vessel increased significantly, with an increase of 22.76%. The secondary reflux velocity decreased significantly, with a relative decrease of 18.26%. The wall shear stress decreased by 2.01% after sand therapy. Conclusions Sand therapy had a significant effect on blood fluidity, by improving blood flow of femoral arteries, and preventing deposition of arterial platelets. The transverse flow phenomenon was obviously weakened after sand therapy, which could avoid the deposition of substances in blood and had a positive effect on the prevention of atherosclerosis, thrombosis and other vascular diseases.

Bioelectrical Impedance Analysis for Body Composition and Nutritional Status in Hospitalized Patients With Inflammatory Bowel Disease / 胃肠病学

Background: Inflammatory bowel disease (IBD) affects the digestive tract, and the prevalence of malnutrition is high. Recently, bioelectrical impedance analysis (BIA) has been frequently used clinically for nutritional assessment. Aims: To study the nutritional status of hospitalized IBD patients through BIA combined with serological indicators. Methods: Data from hospitalized IBD patients who underwent BIA test at Renji Hospital, School of Medicine, Shanghai Jiao Tong University between Jan. and Dec. 2015 were collected retrospectively. In the 198 patients enrolled, 129 were Crohn's disease (CD) and 69 were ulcerative colitis (UC). Serological results, as well as BIA results and related indices were compared between CD and UC patients. Results: The serum vitamin B12 level, body weight and body fat mass were significantly lower in patients with CD than in those with UC (P0.05). Differences in BMI and BCMI between active CD and CD in remission were insignificant (P>0.05). Conclusions: Among the hospitalized IBD patients, males with CD have worse nutritional status than males with UC. Except for serum vitamin B12, there is no significant difference in nutritional status between female CD and female UC patients. BIA related indices are effective tool for assessment of nutritional status, which may be used as a complement to BMI.

Impact of a low-to-middle dosage of glutamine-supplemented total parenteral nutrition on inflammatory markers in patients with inflammatory bowel disease / 中华临床营养杂志

Objective To evaluate the impact of total parenteral nutrition(TPN)on nutrition status and inflammatory markers in hospitalized fasted patients with inflammatory bowel disease(IBD).Methods A retrospective study was performed and 82 hospitalized fasted IBD patients [male/female=58/24,(39.4±14.5)years] who received TPN entered the study.Among them,38 patients had ulcerative colitis(UC)and 44 patients suffered from Crohn`s disease(CD).Clinical data(gender,age,duration of disease,history of disease,prednisone,immuno-suppressor,and antibiotics)were obtained from medical records.Nutritional parameters,C-creative protein(CRP),and erythrocyte sedimentation rate(ESR)before and after TPN were also obtained.Average caloric supplementation by TPN was(4 437.3±1 199.1)kJ/d and the nitrogen amount was(9.9±1.7)g/d.Median PN length was 15 days(7-54 days).67 IBD patients received a TPN formula with glutamine(≥14 d,25 patients vs.0-14 d,42 patients)and 15 IBD subjects received TPN without glutamine.Malnutrition was diagnosed by body mass index(BMI)and serum albumin level.Results The prevalence of undernutrition was 90.2％(74/82)in the study population.CD patients had a significantly longer history of disease [84(3-288)months vs.24(1-324)months,P<0.001] and a significantly lower BMI [(15.6±1.8)kg/m2 vs.(19.1±3.5)kg/m2,P<0.001] compared with those in UC patients.TPN improved nutritional parameters [serum albumin:(28.7±6.6)g/L before TPN vs.(31.7±5.8)g/L after TPN,P<0.001;pre-albumin:(174.1±85.5)mg/L before TPN vs.(227.2±82.8)mg/L after TPN,P<0.001].Conclusions TPN improves nutritional status in hospitalized fasted IBD patients.However,prospective randomized controlled trials are required to estimate the role of low-to-middle dosage of glutamine in IBD patients.

CNTNAP3 Copy Number Variation and its Significance in Crohn's Disease / 胃肠病学

DNA copy number variation is an important pathogenic factor of human diseases and might be involved in the pathogenesis and pathological process of inflammatory bowel disease (IBD).Aims: To investigate the copy number variation of CNTNAP3 gene and its significance in Crohn''s disease (CD).Methods: A total of 101 active CD patients admitted from Jul.2009 to Dec.2010 at Renji Hospital, School of Medicine, Shanghai Jiao Tong University were enrolled.Eighty healthy subjects were served as controls.Peripheral blood or intestinal mucosa samples of CD patients were collected, and the copy number variation of CNTNAP3 gene was screened and validated by array-based comparative genomic hybridization (aCGH, n=8) and real-time PCR (n=93);expression of CNTNAP3 encoding protein was determined by ELISA (n=55).Results: A large fragment copy number amplification was revealed by aCGH at chromosome 9p13 region (including CNTNAP3 gene) in untreated CD patients.Real-time PCR confirmed that the copy number of CNTNAP3 gene was amplified in peripheral blood of CD patients, especially steroid-naive patients as compared with the normal controls (208 616.4±126 984.7 and 233 453.3±113 520.8 vs.161 750.2 ±53 940.3, P0.05).Furthermore, the plasma CNTNAP3 level in CD patients with amplified copy number was not correlated with the simplified endoscopic score for CD (P>0.05).Conclusions: Copy number amplification of CNTNAP3 gene might be involved in the pathogenesis of CD in Chinese population.Glucocorticoid treatment and smoking might affect the copy number variation of CNTNAP3 gene.Plasma CNTNAP3 level cannot discriminate CD patients from healthy subjects.Conclusions of this study needs to be further demonstrated and discussed.

Role of Th17 Cells and Intestinal Flora in Pathogenesis of Inflammatory Bowel Disease / 胃肠病学

Inflammatory bowel disease(IBD)is an autoimmune disease and its etiology has not yet been clarified. Dysregulated immune responses resulted from complex interactions among genetic factors,intestinal flora and environmental cues have been considered as the etiology of IBD. Recently,the relationship between Th17 cells and IBD has become a hotspot of study,and more and more studies showed that Th17 cells and their related cytokines regulated by intestinal flora contributed to the pathogenesis of IBD. This article reviewed the role of Th17 cells and intestinal flora in the pathogenesis of IBD.

Analysis of Chinese and foreign medical education evaluation model / 中华医学教育探索杂志

Assessment mode is a bottleneck in medical education reform nowadays.Although traditional assessment tools,such as written examination,are still widely used in medical education assessments,they have obvious limitations.With the enhancement of requirements in physicians' abilities,assessments on some basic abilities of physicians are still insufficient.The United States and Europe not only focus on the curriculum reform but also the development of appropriate assessment tools,therefore,some new assessment tools are invented.These assessment tools are applicable to the formative assessment and are student-centered,being able to promote the development of education and provide new options for medical education assessments.

Awareness of diagnostic criteria for irritable bowel syndrome in physicians in Shanghai / 中华全科医师杂志

Objective To investigate physicians' awareness of diagnostic criteria for irritable bowel syndrome (IBS). Methods Questionnaire was used to investigate awareness of diagnostic criteria for IBS among 782 physicians in 34 hospitals in Shanghai during August 2008. Results Overall, 82. 7 percent (647/782) of physicians surveyed thought they knew or partly knew diagnostic criteria for IBS. More than 70. 0 percent of physicians knew Rome criteria, but less than 25.0 percent knew other criteria. Awareness of current Rome criteria, whether mental symptoms included in it, and its time frame differed significantly among physicians in varied specialties (P ＜ 0. 01 ). Gastroenterologists had more knowledge about Rome criteria than other specialists, but most physicians, including gastroenterologists, did not fully understand its applicability. Conclusions Although gastroenterologists knew more about diagnostic criteria for IBS, their knowledge still needed to be perfected and updated. Awareness of diagnostic criteria for IBS was poor in nongastroenterological physicians and general practitioners knew it to certain extent.

Study on the function of infliximab in inducing remission in Crohn's disease and followed-up / 中华消化杂志

Objective To explore the function of infliximab in inducing remission in Crohn's disease and the effect of the inducing remission were followed up. Methods Ten patients with Crohn's disease received a infliximab, 5-aminosalicylic acid (5-ASA) and Azathioprine (AZA) therapy for inducing and maintenance remission. Crohn' s disease activity index (CDAI), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine aminotransferase (ALT), apartate aminotransferase, (AST), total bilirubin (TBil), conjugated bilirubin, (CB), creatinine (Scr) were evaluated at week 0, 10, 22 and 50. Simple endoscopic score for Crohn's disease (SES-CD) were evaluated at week 0, 10 and 50. Adverse reactions were also evaluated. Results At week 10, all patients achieved remission. The indicators of CDAI, CRP, ESR and SES-CD were significantly declined than those at week 0 (P＜0.01). The follow-up was terminated in one patient due to the relapse at week 30. At week 50, the indicators of CDAI, CRP, ESR and SES-CD in six patients a little bit increased compared with those at week 10, but no statistic significant (P=0. 2001、0. 0600、0. 1328、0. 4230 respectively), but significantly declined compared with those at week 0 (P =0.0005、0.0087、0.0054、0. 0163 respectively). No severe adverse reaction was observed in all patients.Conclusions Infliximab showed an exact efficacy in inducing remission in Crohn's disease. And 5-ASA and AZA were effective for maintenance remission in part of the patients after infliximab induced remission.

Design of questionnaire on factors for diagnosis of irritable bowel syndrom for physicians / 上海交通大学学报（医学版）

Objective To design a questionnaire on factors that affect diagnosis of irritable bowel syndrome for physicians, and determine the retest reliability. Methods The questionnaire was completed after literature review, and 9 experts were invited to revise the questionnaire. Thirty-four physicians filled the questionnaire for pre-test and did it again for re-test 4 weeks later. Kappa value of each question of the questionnaire was calculated. Results Content validity and face validity were assured by experts. Kappa values were over 0.61 in all items, which achieved substantial level. Conclusion The questionnaire designed has fairly good reliability and validity, and can be used in investigation of irritable bowel syndrome for physicians.