Efficacy of Chinese Medicinal Formulae for Antimicrobial-resistant Pneumonia: A Systematic Review and Meta-analysis / 中国实验方剂学杂志

Objective:To evaluate the efficacy and safety of Chinese medicinal formulae in the treatment of antimicrobial-resistant pneumonia. Method:Following article retrieval from eight databases and data extraction by two reviewers， the methodological quality of the included trials was assessed and the outcome indicators were subjected to Meta-analysis using RevMan 5.3. Result:A total of 24 randomized controlled trials （RCTs） were included， involving 1 818 cases. Meta-analysis showed that Chinese medicinal formulae combined with western routine intervention was superior to the western routine intervention in improving the overall response rate （ORR） ［relative risk （RR）=1.27， 95% confidence interval （CI） （1.21， 1.34）， <inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M005.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M005c.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic></alternatives></inline-formula><0.000 01］， the bacterial clearance rate ［RR=1.49，95% CI （1.33， 1.66）， <inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M006.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M006c.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic></alternatives></inline-formula><0.000 01］， and the clinical pulmonary infection score （CPIS） ［mean difference （MD）=-1.64， 95% CI （-1.87， -1.41）， <inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M007.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M007c.jpg"><?fx-imagestate width="2.28600001" height="2.62466669"?></graphic></alternatives></inline-formula><0.000 01］. There was no significant difference in the incidence of adverse reactions ［RR=0.72， 95% CI （0.48， 1.07），<inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mtext> </mml:mtext><mml:mi>P</mml:mi></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M008.jpg"><?fx-imagestate width="3.04799986" height="2.62466669"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/27038DAF-2FF7-4d58-8001-0E6465A33408-M008c.jpg"><?fx-imagestate width="3.04799986" height="2.62466669"?></graphic></alternatives></inline-formula>=0.1］. The comparison with the western routine intervention also revealed that Chinese medicinal formulae better improved the ORR and CPIS. Conclusion:According to the current research results， the Chinese medicinal formulae alone or combined with western routine intervention yielded more favorable clinical outcomes than western routine intervention in the treatment of antimicrobial-resistant pneumonia， without increasing the incidence of adverse events. Due to limited quality and quantity of the included RCTs， more high-quality trials are required to verify the above conclusions.

Mechanism of Traditional Chinese Medicine in Treating Drug-resistant Bacterial Infection / 中国实验方剂学杂志

The discovery of penicillin has effectively controlled the infection caused by Gram-positive bacteria. Afterwards, the research and development of antibacterial drugs has entered the golden age, and made a great contribution to human health. However, in recent years, with the increasing use of antibiotics around the world, pathogenic bacteria drive gene mutation to obtain drug resistance to ensure its survival advantage, and promote the transfer of drug-resistant genes, resulting in a sharp increase of drug-resistant bacteria. In addition, the current development speed of new antibiotics is far slower than the growth and spread speed of drug-resistant bacteria, which makes the drug-resistant crisis more serious and becomes one of the biggest threats to the global community. Compared with the same type of bacterial infection, drug-resistant bacterial infection has the characteristics of complexity and refractoriness, which causes worse clinical outcome and higher risk of death in patients, and brings severe challenges to clinical work. If the trend of bacterial drug resistance is not controlled, the crisis of no drug available will come. Therefore, it is urgent to explore effective alternative means to fight against bacterial drug resistance and reduce the harm of drug-resistant bacterial infection. Traditional Chinese medicine（TCM） has unique advantages in the treatment of infectious diseases. Compared with modern antibacterial drugs, it has the characteristics of wide sources, rich active ingredients, and is not easy to produce drug resistance. It may be an important source for screening and developing new anti-infective drugs. Therefore, it is promising to develop and utilize TCM to solve the problem of drug-resistant bacteria infection. This paper will review relevant studies in recent years in terms of interfering with the biochemical metabolism of drug-resistant bacteria to directly inhibit or kill drug-resistant bacteria, improving bacterial drug resistance to indirectly inhibit bacteria and kill bacteria, and maintaining the balance of the body and regulating the treatment of drug-resistant bacteria infection as a whole, so as to provide references for guiding clinical medication and research and development of new traditional Chinese medicines.

Clinical outcome of tibiotalocalcaneal fusion using cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcome of tibiotalocalcaneal fusion using cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach.@*METHODS@#From June 2015 to December 2018, 15 patients underwent a tibiotalocalcaneal fusion operation using cannulated screw and inverted proximal humerus locking plate through a transfibular approach. There were 10 males and 5 females with the age ranging from 45 to 72 (58.9±6.1) years, and the course of disease ranged from 2 to 35 (11.9±7.9)years. Preoperative diagnosis included 8 cases of post traumatic arthritis, 2 cases of Charcot arthritis, 2 cases of Charcot-Marie -Tooth (CMT), 1 case of ankle tuberculosis, 1 case of talar necrosis, and 1 case of pigmented villonnodular synovitis. Among them, 8 patients were combined with simple varus deformity, 4 patients with simple valgus deformity, 2 patients with equinovarus deformity, 1 patient with equinovarus deformity, 2 patients with adduction and internal rotation of middle and forefoot. American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and the visual analogue scale (VAS) score were used to evaluate the clinical outcome at the last follow up.@*RESULTS@#One lost follow up and remaining fourteen patients were followed up. The follow up time ranged from 10 to 25(16.6±4.3) months. All the 15 patients had primary healing. Fusion time ranged from 15 to 24 (16.8 ± 2.4) weeks after operation. One patient with diabetes experienced delayed union and was successfully treated with secondary bone grafting combined with Platelet-Rich Plasma (PRP) injection. The AOFAS score increased from 38.7±3.3 to 84.5±2.6 (@*CONCLUSION@#Tibiotalocalcaneal fusion used cannulated screw and humeral proximal locking plate inverted fixation through a lateral transfibular approach has the advantages of relatively simple technique, high fusion rate, especially for patients with posterior foot deformity, which has satisfactory short term effects.

Study on Image Acquisition of Transthoracic Echocardiography in Mechanically Ventilated ICU Patients / 中国医学科学杂志(英文版)

Objective This study aimed to determine which parameters in transthoracic echocardiography (TTE) are more likely to be affected when applied in a critical care setting with mechanical ventilation.Methods Ninety mechanically ventilated ICU patients were enrolled into the study group. The control group consisted of 90 patients who underwent interventional therapy. All patients had bedside TTE for parametric measurements including the right ventricular size, septal kinetics and left ventricular ejection fraction (LVEF) by eyeballing (visual assessment), the tricuspid annular plane systolic excursion (TAPSE), mitral annular plane systolic excursion (MAPSE) by M-mode sonography, the right ventricular outflow tract velocity-time integral (RVOT VTI) and left ventricular outflow tract velocity-time integral (LVOT VTI) by pulse-Doppler, the right ventricular fraction of area change (FAC) and left ventricular ejection fraction (LVEF Simpson) by endocardium tracing. We compared the differences in the frequency of optimal image acquisition in assessments of these parameters between the two groups, as well as the differences in acquisition rates of parameter measurements in ventilated ICU patients.Results There were significantly fewer patients in the study group than in the control group who had optimal images acquisitions for parameter assessments with M-mode method, pulse Doppler method and endocardium-tracing method (

Anterior segment spectral-domain optical coherence tomography in patients with closed globe injury / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the ability of spectral-domain optical coherence tomography(SD-OCT)and slit lamp biomicroscopy to detect anterior segment findings in patients with closed globe injury.<p>METHODS: This is an observational, cross-sectional study. Sixteen patients with a closed globe injury were consecutively recruited from January 2010 to July 2015 in Huizhou Municipal Central Hospital. All patients underwent complete ophthalmic examination, including assessment of visual acuity, measurement of intraocular pressure using a noncontact tonometry, and slit lamp biomicroscopy. SD-OCT was used to examine the anterior segments of all injured eyes. Two patients had bilateral ocular injuries and received bilateral SD-OCT examinations. The OCT findings of the cornea, iris, anterior chamber and lens were recorded and compared with findings seen using slit lamp biomicroscopy.<p>RESULTS: All 18 eyes were examined by SD-OCT had hyphema occupying at least one-third of the anterior chamber volume. Sixteen eyes had corneal edema and corneal abrasion detected on both slit lamp biomicroscopy and OCT examination. OCT examination was also able to detect Descemet's membrane detachment(<i>n</i>=7), angle recession(<i>n</i>=6), lens subluxation(<i>n</i>=3)and iridodialysis(<i>n</i>=3).<p>CONCLUSION: SD-OCT was able to identify features of closed globe injury that were otherwise not visible on slit lamp biomicroscopy. SD-OCT may have advantages over clinical examination in cases of closed globe injury.

Mechanism of Chinese Material Medica in Treatment of Diabetes Mellitus Cerebral Infarction / 中国实验方剂学杂志

Diabetes mellitus complicated with cerebral infarction is the commonest and most serious vascular complication of diabetes mellitus. With a high disability and mortality rate, it seriously threatens human health. Because the pathogenesis is still unclear, more and more scholars have focused on the research of diabetic cerebral infarction at home and abroad. Traditional Chinese medicine(TCM) compounds have a remarkable curative effect in the treatment of diabetic cerebral infarction. Its mechanisms of action mainly include anti-hypertension, reduction of blood sugar and lipid, promotion of vascular regeneration and vascular endothelial function, anticoagulation, anti-thrombosis, improvement of nerve function defect, reduction of infarct volume, improvement of hemorheological, inhibition of inflammation and platelet aggregation, and promotion of collateral circulation. Through literature search, this paper summarizes the research progress of the mechanisms of TCM compounds in treating diabetic cerebral infarction in recent five years at home and abroad, in order to provide reference for clinical treatment.

Effect of Kuanxiong Lifei decoction on inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease and syndrome of turbid phlegm obstructing lung :a multicenter prospective study / 中国中西医结合急救杂志

Objective To investigate the effect of Kuanxiong Lifei decoction on inflammatory factors in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and turbid phlegm obstructing lung syndrome. Methods Two hundred patients with AECOPD and turbid phlegm obstructing lung syndrome diagnosed by traditional Chinese medicine (TCM) differentiation visiting four hospitals of Longhua Hospital Affiliated to Shanghai University of TCM, Shanghai Seventh People's Hospital, Punan Hospital of Shanghai Pudong New Area, Gongli Hospital of Shanghai Pudong New Area were selected from May 2017 to March 2018, and they were divided into a test group and a control group by a random number table, 100 cases per group. The patients in the two groups were treated with routine western medicine according to the guidelines, and in the test group, additionally Kuanxiong Lifei decoction (components: pinellia ternate 15 g, allium macrostemon 12 g, ephedra 9 g, trichosanthes 30 g, poria cocos 15 g, almond 12 g, lumbricus 12 g, citrus peels 12 g, peach kernel 12 g , roasted licorice 6 g) was used for 10 days, the decoction was uniformly made by Chinese Medicine Pharmacy of Longhua Hospital, 1 dose daily, 2 times a day orally taken, warm 200 mL each time, 0.5 hours before or after meal. The efficacy was evaluated after treatment for 10 days. The level changes of white blood cell count (WBC), neutrophils (N), C-reactive protein (CRP), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) before and after treatment and the improvement of TCM syndrome scores and clinical efficacy were observed in two groups. Results After treatment, the levels of WBC, N, CRP, IL-8, TNF-α, TCM syndrome score of the patients in the two group were significantly decreased compared with those before treatment in the two groups (P < 0.05), and the above indexes in the test group were all significantly lower than those in the control group after treatment [WBC (×109/L): 6.58±1.41 vs.7.44±1.85, N: 0.58±0.08 vs. 0.64±0.08, CRP (mg/L): 7.3±1.8 vs. 9.6±1.7, IL-8 (ng/L): 23.5±6.2 vs. 27.8±9.8, TNF-α (ng/L): 9.45±2.18 vs. 10.25±1.67, TCM syndrome total score: 4.0 (3.0, 8.0) vs. 8.0 (5.0, 10.0), all P < 0.05]. The total effective rate of the test group was significantly higher than that of the control group [88% (88/100) vs. 84% (84/100), P < 0.05]. Conclusion Kuanxiong Lifei decoction can significantly reduce lung inflammatory factors, ameliorate overall symptoms and improve the prognosis of AECOPD patients with turbid phlegm obstructing lung syndrome.

Contrast observation of MSCT findings of pulmonary lymphoma with pathological features / 实用放射学杂志

Objective To study the MSCT findings of pulmonary lymphoma,and improve its imaging diagnostic accuracy.Methods The MSCT findings of 14 patients with pathologically proven pulmonary lymphoma were reviewed retrospectively.Evaluated imaging findings included distribution position,number,shape,density and accompanying signs of the lesion.Results In 14 cases of pulmonary lymphoma,except for miliary shadow,there were 108 lesions,including small nodules,nodules,masses,consolidation,ground-glass density and meshlike shadow.Solitary lesions were founded in 2 and multiple lesions were founded in 12 of 14 cases,which the multiple lesions found in single lung in 3 cases,and multiple lesions found in both lungs in 9 cases.There were 24 lesions in 7 cases of pulmonary consolidation, including air bronchogram in 6 cases and bronchiectasis in 3 cases.There were 7 cases with masses,5 cases with nodules,5 cases with small nodules,2 cases with ground-glass density,2 cases with pulmonary interstitial changes,2 cases with CT angiogram sign,4 cases with pleural effusion and 3 cases with mediastinal or pulmonary hilar lymphadenopathy.Conclusion The mainly MSCT findings of pulmonary lymphoma was pulmonary consolidation with air bronchogram,or masses,or nodules,or multiple signs exist at the same time.The diagnosis is mainly based on histopathology.

A new dimeric xanthanolide from fruits of Xanthium chinense / 中国中药杂志

Through the methods of polyamide resin， Sephadex LH-20， ODS column chromatography and preparative HPLC etc.， 7 compounds were isolated from the 70% ethanol extract of the fruits of Xanthium chinense. Based on ESI-MS and NMR data， the structures of these compounds were identified as pungiolide O(1)， grasshopper ketone(2)， icariside F₂(3)， 7-[(β-D-apiofuranosyl-(1→6)-β-D-glucopyranosyl)oxymethy]-8，8-dimethyl-4，8-dihydrobenzo[1，4]thiazine-3，5-dione(4)，(6R，9S)-3-oxo-α-ionol β-D-glucopyranoside(5)， cryptochlorogenic acid methyl ester(6)， and chlorogenic acid methyl ester(7). Among them， compound 1 is a new compound.

Research progress on mechanisms of Chinese materia medica in treatment of hypertension / 中草药

Primary hypertension, known as one of the most common diseases of the time, is thought to be determined by the combined effect of several risk factors and stages, especially for the interaction of genetic and environmental factors. However, the mechanisms of genetic and environmental factors leading to the increased blood pressure are still not clear. Previous studies appear that Chinese materia medica (CMM) compound shows a good effect in the treatment of hypertension, its mechanisms for the action are mainly related to the activation of the rennin-angiotensin-aldosterone system (RAAS), calcium antagonists, blood vessels dilation, the improvement of endothelial function, hemorheology, and insulin resistance. It may also relate to diuretic, the regulation of the blood lipids, AR, ER alpha, and the loss of weight, etc. Therefore, this review summarizes the research progress at home and abroad on the mechanisms of CMM compound in the treatment of hypertension in recent years, aiming to provide information for the clinical treatment of hypertension.

Design,synthesis and preliminary anti-radiation activityof novel LPA2 receptor agonists / 国际药学研究杂志

Objective To design and synthesize novel G protein-coupled lysophosphatidic acid 2(LPA2)receptor agonists with anti-radiation activity. Methods Nine new LPA2 receptor agonists(Ⅰ2-Ⅰ5 andⅡ1-Ⅱ5)were designed and synthesized using DBIBB as the lead compound. The anti-radiation activity was assayed by the MTS method using the human umbilical vein endothelial cells(HUVEC)irradiated with 8.0 Gy 60Coγray. Results and Conclusion Nine target compounds notreported in the literature were synthesized and their structures were confirmed by 1H NMR and MS. The results showed thatⅠ4 andⅡ1 have obvious anti-radiation ac-tivity,indicating that this kind of compounds is worth further studying.

CT and MRI diagnose of primary extragonadal seminoma / 实用放射学杂志

Objective To explore the CT and MRI performances of primary extragonadal seminoma .Methods The imaging find‐ings of primary extragonadal seminoma in 16 patients proved by histopathology were analyzed retrospectively .The tumor location , size ,contour ,periphery ,density or signal and contrast enhancement patterns were evaluated ,and these were compared with the pathological results .Results The lesions in 16 patients were solitary including the ovoid lesions in 6 and lobulated ones in 10 .They were located in intracranial area in 10 patients ,anterior middle mediastinum in 4 and abdomen in 2 .Mean size of the tumors was(7 .0 ± 5 .6) cm (ranging from 1 .3 cm to 18 .6 cm) .Unenhanced CT in 13 patients showed the soft tissue masses with necrosis in 8 ,stip‐pled calcification in 2 and hemorrhage in 2 .Enhanced CT in 6 patients showed homogeneity in 2 and heterogeneity in 4 ,and the de‐grees of enhancement increased gradually .The plain and enhanced MRI in 10 patients showed iso‐or slight hypointensity on T1WI and slight hyperintensity on T2 WI in 8 lesions ,heterogeneous enhancement in 7 and slight enhancement in one ,peripheral enhance‐ment in 2 due to central hemorrhage .Pathology showed most of the lesions were well‐vascularized with inner cystic change .Tumor stroma was divided by the fibrovascular tissue .Conclusion The imaging findings of primary extragonadal seminoma are not specific , CT ,MRI can demonstrate the invasive extent accurately .

Expression of XPG Gene in Forensic Age Estimation / 法医学杂志

OBJECTIVES@#To explore the expression of xeroderma pigmentosum complementation group G （XPG） gene in healthy Han population of different ages and to analysis the relationship between the mRNA and protein expression levels of XPG and age, which may provide a new molecular-biological indicator for forensic age determination.@*METHODS@#Total 150 samples of peripheral blood were collected from healthy Han population of different ages. Total RNA of peripheral blood mononuclear cell （PBMC） were extracted by TRIzol method, and the relative expression of XPG mRNA in PBMC was detected by quantitative real-time PCR, and the protein expression levels of XPG in plasma were detected by ELISA.@*RESULTS@#The mRNA and protein expression levels of XPG in ≤18 years old group were significantly different from 19-45 years old group and ≥46 years old group （P<0.05）, while there was no significant difference between 19-45 years old group and ≥46 years old group （P>0.05）. No significant sex differences were observed in mRNA and protein expression levels of XPG （P>0.05）.@*CONCLUSIONS@#The relative expression level of XPG mRNA in PBMC declines with the increase of age in younger age, while the protein expression level in plasma increases with age, and XPG gene can be used as one of new markers for forensic age estimation.

Effect of p65 gene inhibited by siRNA on differention of rat marrow mesenchymal stem cells into neurons / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To investigate the effect of p65 gene inhibited by siRNA on neuronic differentiation in the marrow mesenchymal stem cells (MSCs).</p><p><b>METHODS</b>The MSCs were transfected with Rn-p65-siRNA. Fasudil hydrochloride induced MSCs differentiating into neurons. The non-transfected group and negative control group (transfected with negative control siRNA marked by Cy3) were used as controls. The fluorescence expressed by transfected MSCs were observed under inverted fluorescence microscope at 24 h,48 h and 72 h after transfected with negative control siRNA. The viability of MSCs was detected by MTT at 24 h, 48 h and 72 h after transfected with Rn-p65-siRNA. The expressions of p65 mRNA and protein in MSCs were detected by RT-PCR and Western blot respectively. The expressions of p65 protein, NSE, MAP-2 and glial fibrillary acidic protein (GFAP) were detected by immunocytochemical method after transfection for 6 h.</p><p><b>RESULTS</b>The fluorescence of MSCs was mostly displayed after transfection of 72 hours and the efficiency of transfection was up to 83.3% ± 3.8%. Meanwhile, the p65 mRNA and p65 protein expressed by MSCs of transfected group were significantly decreased (P < 0.05); MTT displayed that the viability of MSCs was also significantly reduced (P < 0.05). The best efficiency of induction was observed in the transfected group. There were higher expressions of NSE and MAP-2 than the other group (P < 0.05).</p><p><b>CONCLUSION</b>The p65 gene inhibited by siRNA can promote the marrow mesenchymal stem cells to differentiate into neurons.</p>

Study on intestinal absorption features of oligosaccharides in Morinda officinalis How. with sigle-pass perfusion / 中国中药杂志

To study the in situ intestinal absorption of five oligosaccharides contained in Morinda officinalis How. (sucrose, kestose, nystose, 1F-Fructofuranosyinystose and Bajijiasu). The absorption of the five oligosaccharides in small intestine (duodenum, jejunum and ileum) and colon of rats and their contents were investigated by using in situ single-pass perfusion model and HPLC-ELSD. The effects of drug concentration, pH in perfusate and P-glycoprotein inhibitor on the intestinal absorption were investigated to define the intestinal absorption mechanism of the five oligosaccharides in rats. According to the results, all of the five oligosaccharides were absorbed in the whole intestine, and their absorption rates were affected by the pH of the perfusion solution, drug concentration and intestinal segments. Verapamil Hydrochloride could significantly increase the absorptive amount of sucrose and Bajijiasu, suggesting sucrose and Bajijiasu are P-gp's substrate. The five oligosaccharides are absorbed mainly through passive diffusion in the intestinal segments, without saturated absorption. They are absorbed well in all intestines and mainly in duodenum and jejunum.

Efficacy of splenectomy plus selective pericardial devascularization under en-doscope in treatment of advanced schistosomiasis patients with portal hyper-tension and hypersplenism / 中国血吸虫病防治杂志

Objective To evaluate the efficacy of splenectomy plus selective pericardial devascularization under endoscope in the treatment of advanced schistosomiasis patients with portal hypertension and hypersplenism so as to explore the minimally in-vasive and safer surgical treatment. Methods A secure splenectomy was performed with laparoscope and its supporting devices, and at the same time,the ligation of the left gastric vein and the ligation of esophageal vein perforating vertically into the esopha-gus were also performed in 14 advanced schistosomiasis patients with portal hypertension and hypersplenism. Results Among the 14 patients,the splenic artery was separated and clipped before the treatment of splenic pedicle. One patient was of conversion to open laparotomy for the splenic vein rupture bleeding in the separation. There was no death. Conclusion The operation of sple-nectomy plus selective pericardial devascularization under endoscope is effective,truly minimally invasive,and safe in the treat-ment of advanced schistosomiasis patients with portal hypertension and hypersplenism.

Revisiting the TALE repeat

Transcription activator-like (TAL) effectors specifically bind to double stranded (ds) DNA through a central domain of tandem repeats. Each TAL effector (TALE) repeat comprises 33-35 amino acids and recognizes one specific DNA base through a highly variable residue at a fixed position in the repeat. Structural studies have revealed the molecular basis of DNA recognition by TALE repeats. Examination of the overall structure reveals that the basic building block of TALE protein, namely a helical hairpin, is one-helix shifted from the previously defined TALE motif. Here we wish to suggest a structure-based re-demarcation of the TALE repeat which starts with the residues that bind to the DNA backbone phosphate and concludes with the base-recognition hyper-variable residue. This new numbering system is consistent with the α-solenoid superfamily to which TALE belongs, and reflects the structural integrity of TAL effectors. In addition, it confers integral number of TALE repeats that matches the number of bound DNA bases. We then present fifteen crystal structures of engineered dHax3 variants in complex with target DNA molecules, which elucidate the structural basis for the recognition of bases adenine (A) and guanine (G) by reported or uncharacterized TALE codes. Finally, we analyzed the sequence-structure correlation of the amino acid residues within a TALE repeat. The structural analyses reported here may advance the mechanistic understanding of TALE proteins and facilitate the design of TALEN with improved affinity and specificity.

The prenatal diagnosis for absence of fetal cavum septum pellucidum by ultrasonography / 中华医学超声杂志（电子版）

Objective To explore the clinical significance of prenatal diagnosis for absence of fetal cavum septum pellucidum (CSP) by ultrasonography. Methods The ultrasonographic characteristics were retrospectively analyzed in 63 fetuses, whose CSPs were not detected in prenatal two and three dimensional ultrasonography in Nanjing Medical University Affiliated Suzhou Hospital. Results In 63 fetuses with absent CSP, the related malformations included:(1) Five cases were diagnosed as agenesis of corpus callosum (ACC, including four complete ACC and one partial ACC);(2) Twenty-seven cases were diagnosed as holoprosencephaly (HPE, including 18 alobar HPE, ifve semilobar HPE and four lobar HPE);(3) One case was diagnosed as schizencephaly;(4) Two cases were diagnosed as porencephaly;(5) Five cases were diagnosed as hydranencephaly;(6) Twenty-three cases were diagnosed as severe hydrocephalus, among which ifve cases were caused by aqueductal stenosis and the other 18 cases were caused by open spina biifda (Chiari Ⅱ malformation). These absent CSP fetuses had other abnormalities including one case of Dandy-Walker Malformation, one case of Dandy-Walker Variation, 14 cases of median cleft lip, ifve cases of single naris, two cases of proboscis nose, three cases of talipes foot and four cases of single umbilical artery, etc. These 63 cases were all followed up after prenatal ultrasonography but 4 cases were missed and one case of septo-optic dysplasia was misdiagnosed as lobar HPE. The diagnoses of other 58 fetuses by ultrasonography were conifrmed by follow up. Conclusions CSP is considered as an essential part in prenatal evaluations of the fetal central nervous system during second-and third-trimester. Absence of CSP is always accompanied with an extremely wide spectrum of fetal neuroanatomic malformations, including prosencephalon diseases, intracranial midline anomalies, etc. Prenatal ultrasonography is the best choice for the observation of CSP.

The application of fetal echocardiography in prenatal diagnosis of total anomalous pulmonary venous connection / 中华医学超声杂志（电子版）

Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC). Methods Fetal echocardiographic images of 13 fetuses with TAPVC conifrmed by pathology or postnatal echocardiography were reviewed. Echocardiographic features and clinical signiifcance of prenatal diagnosis of TAPVC were summarized. Results Twelve fetuses with TAPVC were diagnosed prenatally by fetal echocardiography, including seven cases of supracardiac type, three cases of infracardiac type and two cases of intracardiac type. The common echocardiographic characteristics of 12 fetuses with TAPVC included slightly size discrepancy of left heart and right heart, large foramen ovale with increased shunting at the atrial level, increased distance between left atrium (LA) and descending aorta, absent insertions of pulmonary veins in the LA, presence of pulmonary venous conlfuence on the top of LA and dilatation of vessels where pulmonary venous conlfuence drained. One case was missed prenatally and intracardiac type TAPVC was diagnosed by postnatal echocardiography. Among the 13 cases, three were isolated and the other ten were all in association with other abnormalities. Conclusions There are fetal echocardiographic characteristics of TAPVC. Fetal echocardiography plays an important role in prenatal diagnosis of TAPVC.

Prenatal ultrasound of fetus with echogenic bowel and complicated structural abnormalities/chromosome abnormality / 中华医学超声杂志（电子版）

Objective To explore the prenatal ultrasonographic features of fetuses diagnosed as echogenic bowel and chromosomal abnormalities. Methods From September 2009 to June 2013, eighty cases diagnosed as echogenic bowel by prenatal ultrasound screening in our hospitals underwent chromosomal karyotype analysis and were followed up till fetal birth. The prenatal ultrasonographic features were carefully correlated with the postnatal findings. Results Prenatal ultrasoundand chromosomal findings of the 80 cases were:(1) Fifty-eight cases of fetuses with echogenic bowel alone (72.5%, 58/80, without chromosomal karyotype abnormalities). (2) Eleven cases of fetuses with additional ultrasound soft markers (13.8%, 11/80, without chromosomal karyotype abnormalities). The ultrasound examination revealed 8 cases of choroid plexus cysts, 1 case of single umbilical artery, 1 case of shorter nasal bone, and 1 case of echogenic intracardiac focus. (3) Five cases of fetuses with severe functional abnormalities or complex structural malformations and normal chromosomal karyotype. The ultrasound examination revealed 3 cases of structural cardiac malformations, 1 case of heart failure and 2 cases of central nervous system malformations. Of them,one case showed complex malformations (right ventricular dysplasia syndrome, cerebellar dysplasia and single umbilical artery), whereas the remaining 4 cases only involve single malformation. (4)Six cases had chromosomal abnormalities (7.5%, 6/80), including 3 cases of abnormal chromosome microdeletions, and 3 cases of abnormal chromosome numbers (1 21-trisomy syndrome, 1 18-trisomy syndrome, and 1 triploid syndrome). All of them had severe structural malformations and abnormal soft markers. The ultrasound examination revealed 2 cases of severe cardiac malformations, 2 cases of central nervous system malformations, 1 case of pericardial/peritoneal effusion, and 1 case of placental chorionic multiple hemangioma. One case of holoprosencephaly (donor of the twins) ended with intrauterine death. The associated abnormal soft markers include nuchal fold (NF) thickening, choroid plexus cysts, umbilical cord cysts, single umbilical artery, and placental chorionic hemangioma. Conclusions The fetuses with echogenic bowelaloneusualyhaveagoodprognosis.Insomecases,echogenicbowelmaydisappearduringvfolow-up.The fetuses complicated with severe structural malformations and chromosomal abnormalities have poor prognosis. For the fetuses diagnosed of echogenic bowel by prenatal ultrasound screening, systematic ultrasound examination should be carried out and clinical chromosomal karyotype analysis was suggested.