Application and exploration of virtual reality technology in surgical practice and medical education / 中华消化外科杂志

Virtual reality (VR) is a technology that interacts computer-generated three-dimensional scenes with the user′s senses and has been gradually applied in the real medical field. Since the first time of successful attempt in 3D laparoscopic gastrointestinal surgery VR living video broadcast in 2016, the authors have experienced the exploration of the application of this technology (2016-2017) as well as the in-depth research phase (2018-2019). Nowadays, the VR application in our center has entered into the application practice phase (2020 to present). With the technology iteration and more and more application experience acquisition, our current VR application mainly focuses on two practice settings, including the clinical teaching scenarios for early exposure to acute appendicitis for medical undergraduate students and the preoperative communication to give pati-ents an early sense of the process in the operating theatre, and has achieved good application results. With continuous breakthroughs and innovations in software and hardware, we believe that more clinical VR scenarios and the course audience will be expanded to a wider group. The integration of some new hotspots such as Meta-Universe and ChatGPT will make up for the shortcomings in VR content scenarios and interactivity, and its application prospects are infinite.

Implementation effect and thought of the basic essential surgical training course of laparoscopic skills / 中华医学教育探索杂志

Objective:To analyze and summarize the implementation effect of basic essential surgical training (BEST) course of laparoscopic skills over the past 10 years and the practical experience in updating course content and models.Methods:The pre-class assessment questionnaires, basic laparoscopic operation assessment results, and post-class assessment questionnaires of the students who participated in the BEST course of laparoscopic skills were collected. According to the period of the course construction, the students were divided into two groups, namely students who used the course of single training system in the early stage (traditional group) and students who used the course integrating a variety of training systems after the course model was updated in the later stage (test group). The two groups were compared for the scores of track circle moving, tunnel crossing, and high and low columns, as well as their subjective evaluation of course setting and implementation effect. The t-test, Wilcoxon test, or chi-square test was conducted according to the data type using SPSS 13.0. Results:The time for 150 traditional group students to complete track circle moving, tunnel crossing, and high and low columns was 1.08 min (0.81 min, 1.60 min), 2.20 min (1.60 min, 3.27 min), and 4.86 min (3.28 min, 6.36 min), respectively, while the time for 75 test group students to complete the three operations was 1.27 min (0.87 min, 1.83 min), 2.57 min (1.58 min, 4.07 min), and 4.35 min (2.90 min, 6.42 min), respectively, with no significant difference between the two groups ( P>0.05). In terms of students' subjective evaluation of the course, a higher percentage of the test group students were satisfied with classroom environment, teaching method arrangement, training equipment, training opportunities, helping clinical work, and meeting pre-class expectations than those in the traditional group. Conclusion:The constantly updated BEST course can ensure the training quality of trainees and obtain their higher satisfaction. The benefits of this course in clinical practice can be further verified through long-term follow-up of these trainees.

Clinical value of a novel biological mesh in laparoscopic inguinal hernia repair: a multicenter prospective randomized controlled study / 中华消化外科杂志

Objectives:To investigate the clinical value of a novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair.Methods:The prospective randomized controlled study was conducted. The clinical data of 50 adult patients with unilateral inguinal hernia who were admitted to 3 medical centers, including Ruijin Hospital of Shanghai Jiaotong University School of Medicine et al, from September 2019 to March 2020 were selected. Based on random number table, patients were divided into two groups. Patients using the novel non-crosslinked biological mesh in repair surgery were divided into the experiment group and patients using the lightweight, micro-porous, partially absorbable synthetic mesh in repair surgery were divided into the control group. Observation indicators: (1) grouping situations of the enrolled patients; (2) endpoint of the study. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter rank sum test. Count data were described as absolute numbers and (or) persentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the non-parameter rank sum test. Repeated measurement data were analyzed using the repeated ANOVA. Taking the recurrence rate of hernia as the basis of efficacy evaluation, according to the intention-to-treat analysis, the confidence interval method (Newcombe Wilson method) was used to conduct non-inferiority statistical analysis of the recurrence rate of hernia between the experiment group and the control group. If the upper limit of 95% confidence interval of the difference of recurrence rate of hernia between the experiment group and the control group is less than 10%, the experiment group is considered to be non-inferior to the control group. Results:(1) Grouping situations of the enrolled patients. A total of 50 adult patients with inguinal hernia were selected for eligibility. There were 44 males and 6 females, aged (60±15)years. All 50 patients were randomly divided into to the experiment group and the control group with 25 cases each. One patient in the control group was not followed up at postoperative month 2, and the rest of 49 patients completed all expected follow-up. No patient in the two groups fell off or were removed. (2) Endpoint of the study. ① The primary endpoint of study. The recurrence rate of hernia was 0 in the experiment group, versus 4%(1/25) in the control group, respectively, showing no significant difference between the two groups ( P>0.05). Results of non-inferiority statistical analysis showed that the 95% confidence interval of the difference of recurrence rate of hernia between the two groups was -19.54% to 9.72%, with the upper limit as 9.72%, which was less than 10%. ② The secondary endpoint of study. There were 2 patients in the control group occurred seroma at postoperative day 14, and none of the rest of patient in the two groups occurred seroma during the follow-up, showing no significant difference in the occurrence of seroma between the two groups ( P>0.05). There was 1 patient in the control group feeling discomfort or foreign body sensation in groin area at postoperative month 2, and none of the rest of patient in the two groups feeling discomfort or foreign body sensation in groin area during the follow-up, showing no significant difference in the feeling discomfort or foreign body sensation in groin area between the two groups ( P>0.05). There was no patient occurred surgical site infection in the experiment group, and there was 1 patient in the control group occurred postoperative skin infection, which had no relationship with mesh. There was no patient in both two groups occurred fever, anaphylaxis and patch related serious adverse reaction during the follow-up. The resting visual analogue scale score, active visual analogue scale score of patients at postoperative 2 days and postoperative 18 months were 0.44±1.00, 1.28±1.46 and 0, 0 in the experiment group, versus 0.40±0.76, 1.28±1.14 and 0.24±1.20, 0.44±1.29 in the control group, respectively. There was a significant difference in the time effect of postoperative active visual analogue scale score of patients between the two groups ( Ftime=10.19, P<0.05). The thickness of the novel non-crosslinked biological mesh before implantation was 0.5?0.7 mm. Two months after operation, results of B-ultrasonic examination in groin area of 10 patients from the experiment group showed a strong echo area at the patch implant area with a thickness as 2 mm. Conclusion:Application of novel non-crosslinked biological mesh in laparoscopic inguinal hernia repair is safe and effective.

Safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure for low rectal cancer / 中华消化外科杂志

Objective To investigate the safety and short-term outcomes of laparoscopic abdominoperineal resection with pelvic peritoneum closure (LARP-PPC) for low rectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 132 patients with low rectal cancer who were admitted to Ruijin Hospital of Shanghai JiaoTong University School of Medicine from January 2014 to December 2017 were collected.There were 81 males and 51 females,aged from 45 to 83 years,with an average age of 62 years.Among the 132 patients,60 undergoing LARP-PPC were allocated into LARP-PPC group,and 72 patients undergoing conventional LARP were allocated into LARP group.All the patients received standardized preoperative and postoperative treatments.Observation indicators:(1) surgical and postoperative conditions;(2) postoperative pathological examination;(3) postoperative complications.The measurement data with normal distribution were expressed as Mean±SD,and the t test was used for comparison between groups.The measurement data with skewed distribution were expressed as M (range),and the Mann-Whitney U test was used for comparison between groups.The count data were expressed as absolute numbers,and the chi-square test or the Fisher exact probability was used for comparison between groups.Mann-Whitney U test was used for comparison of ordinal data between groups.Results (1) Surgery and postoperative conditions:all the patients in the two groups underwent successful surgery without conversion to open surgery.The operation time,volume of intraoperative blood loss,time to first flatus,and time to first liquid intake of the LARP-PPC group were (163±45) minutes,168 mL(range,85-280 mL),2 days(range,1-5 days),3 days(range,2-6 days),versus (155±39) minutes,160 mL(range,100-305 mL),3 days(range,1-7 days),4 days(range,2-7 days) of the LARP group;there was no differencebetween the two group (t =1.113,Z =-1.623,-1.468,-0.321,P＞0.05).The duration of postoperative hospital stay in the LARP-PPC group and the LARP group were 16 days (range,11-21 days) and 19 days (14-24 days),respectively,with a significant difference between the two groups (Z =-5.888,P＜0.05)].In the LARP-PPC group,time of PPC was (13± 3) minutes.(2) Postoperative pathological examination:the length of specimen,the number of lymph node dissection,tumor diameter,cases with high-,middle-,and low-differentiated tumor in the LARP-PPC group was (18±4)cm,16±t5,(3.7±1.4)cm,10,34,16 in the LARP-PPC group,and (18±4)cm,16±5,(3.9±1.5) cm,13,41,18 in the LARP group,showing no significant difference between the two groups (t =0.779,0.390,0.703,Z=-0.267,P＞0.05).(3) Postoperative complications:cases with perineal wound infection,delayed perineal wound healing,intestinal obstruction,and perineal hernia were 2,1,1,0 in the LARP-PPC group,and 12,10,8,6 in the LARP group,showing significant differences between the two groups (x2 =6.137,6.400,P＜0.05).There were 2 and 4 patients with urinary tract infection in the LARP-PPC group and the LARP group,respectively,showing no significant difference between the two groups (P ＞ 0.05).Conclusion LARP-PPC is safe and feasible for the treatment of low rectal cancer,which can significantly reduce postoperative perineal-related complications and consequently shorten postoperative hospital stay.

Application value of the modified Overlap esophagojejunostomy in totally laparoscopic total gastrectomy / 中华消化外科杂志

Objective To investigate the application value of the modified Overlap esophagojejunostomy in totally laparoscopic total gastrectomy (TLTG).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 32 patients who underwent TLTG with modified Overlap esophagojejunostomy in the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between January 2015 and December 2017 were collected.The main points of the modified Overlap method:surgeons stood on the right of patients when digestive tract reconstruction,suspension of left half liver and clockwise rotation before esophageal transection were performed,regulating esophageal opening position and building jejunal loop,and then closing openings using 45.0 mm Endo-GIA and barbed wire.Patients who were diagnosed as Ⅰ A stage by postoperative pathological examination were followed up;patients with lymph node metastases underwent chemotherapy of XELOX regimen and patients in Ⅰ B and Ⅱ stages without lymph node metastases underwent oral S-1 single agent.Observation indicators:(1) surgical and postoperative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy,long-term complications and survival up to March 2018.Measurement data with normal distribution were represented as x±s,and measurement data with skewed distribution were described as M(range).Results (1) Surgical and postoperative recovery situations:all the 32 patients underwent successful TLTG and modified Overlap esophagojejunostomy.The operation time,esophagojejunostomy time,volume of intraoperative blood loss,time to initial anal exsufflation,time for initial fluid diet intake,time for initial semifluid diet intake and time of postoperative drainage-tube removal were respectively (227 ± 19) minutes,(22 ±7)minutes,(69±11)mL,(2.1±0.5) days,(3.4±0.4) days,(4.9±0.6) days and (7.5±1.7) days.There was no anastomotic stoma-related complication in 32 patients.One patient was complicated with duodenal stump leakage at 5 days postoperatively and was cured by continuous three-cavity irrigation and conservative treatment.Results of postoperative pathological examination:number of lymph node dissected in 32 patients was 32±4.TNM staging:1,5,7,11,6,1 and 1 patients were detected respectively in Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B,ⅢA,ⅢB and ⅢC.Duration of postoperative hospital stay of 32 patients was (8.1 ±2.1)days.(2) Follow-up and survival situations:32 patients were followed up for 3-38 months,with a median time of 18 months.During the follow-up,in addition to 1 patient in IA stage,31 patients underwent postoperative adjuvant therapy;patients can take the common soft food,without symptoms of choking and burning feelings,and gastroscopy reexamination was performed at 6 months postoperatively and showed anastomosis patency.One patient died of malignant tumor of maxillary sinus at 9 months postoperatively,1 was detected liver metastasis at 20 months postopeartively and survived with tumor,the other patients had no tumor recurrence or metastasis.Conlusion The modified Overlap esophagojejunostomy is safe and feasible in TLTG,with good short-term outcomes.

Clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti / 中华消化外科杂志

Objective To investigate the clinical efficacy of laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti.Methods The retrospective cross-sectional study was conducted.The clinical data of 14 patients with postpartum diastasis recti who were admitted to Ruijin Hospital of Shanghai Jiaotong University School of Medicine between June 2016 and June 2018 were collected.Patients underwent laparoscopic-assisted linea alba reconstruction.Observation indicators:(1) intra-and post-operative recovery situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,diastasis recti and umbilical hernia recurrence up to September 2018.Measurement data with normal distribution were represented as (x)±s and measurement data with skewed distribution were described as M (P25,P75).Results (1) Intra-and post-operative situations:14 patients underwent successful laparoscopic-assisted linea alba reconstruction and 8 complicated with umbilical hernia area of (6± 3) cm2 were sutured and closed.The mesh area,operation time,visual analogue score for pain at the first day after operation,time of postoperative drainage-tube removal and duration of postoperative hospital stay were respectively (214±26) cm2,(74 ± 14) minutes,3.7 ± 0.6,(3.3 ± 0.7) days and (4.1 ± 1.2) days.No patient required administration of analgesics and had postoperative complication.(2) Follow-up:14 patients were followed up for 17 months (5 months,21 months).During the follow-up,1 patient returned visit at postoperative day 10 due to surgical incision drainage and cured after dressing change.The other patients had no complications,without diastasis recti and umbilical hernia recurrence.Conclusion Laparoscopic-assisted linea alba reconstruction for postpartum diastasis recti is safe and effective.

Anatomical strategies of Henle trunk in laparoscopic right hemi-colectomy for right colon cancer / 中华胃肠外科杂志

The advancement of laparoscopic surgery serves as a trigger for better understanding of the vascular structure at the inferior border of the pancreas, especially Henle trunk. Henle trunk was first found as convergence to superior mesenteric vein (SMV) conjoined by sub-right colon vein (SRCV) and right gastroepiploic vein (RGEV), but decades later, anterior superior pancreatic duodenal vein (ASPDV) was described as another conjoint vein of Henle trunk. These tributaries are the basic elements of Henle trunk in early years' study. A proper surgical procedure for Henle trunk can significantly reduce the complications of radical right hemi-colectomy (Japanese D3 resection and European complete mesocolic excision, CME). There are four variations of Henle trunk according to the colic venous tributaries that consists the anatomic variations in transverse colon posterior space(TRCPS). These variations are like "fingerprint and pattern" of CME. The recognition and extension of the TRCS is the key to the dissection of Henle trunk in laparoscopic right hemi-colectomy. Our medical center proposed four feasible approaches for extension:(1) hybrid medial approach; (2) completely medial approach; (3)completely medial access by "page-turning" approach; (4) completely medial approach along RCV. Mostly, RCV ended in Henle trunk, and completely medial approach along RCV is efficient to identify the Henle trunk in CME. We suggest dissecting the inferior margin of pancreas along SMV in a bottom-to-top fashion, followed by the dissection of middle colic vessels to reveal the root of Henle trunk. And it's better to dissect Henle trunk by branch rather than at its root for safety. Here, we describe the anatomic characters of Henles trunk, the surgical approach and strategies of Henle trunk in laparoscopic surgery.

Technique of dissection in the pre-rectal space of laparoscopic total mesorectal excision / 中华消化外科杂志

The development of laparoscopic total mesorectal excision (TME) has been promoting the better understanding of the anatomy in pre-rectal space for surgeons.If the dissection in pre-rectal space was inappropriate and entered into wrong anatomic planes,it would be easier to cause the proper fascia of rectum incomplete and damage the neurovascular bundies,and reduce the radical surgery outcome and induce urinary and sexual dysfunction,finally,affect the prognosis in patients.For surgical approach in pre-rectal space,the author proposed:Based on the related literatures,transecting the Denonvilliers' fascia (DVF) when it's definitely thickened after cutting the peritoneum 0.5 cm anterior to peri-toneal reflection,entering and dissecting in the space between DVF and the proper fascia of rectum,and forming a typical Three-line feature,including the cutting line of peritoneal reflection,the proximal and distal cutting lines of DVF,which can serve as the mark line and mark plane of the entrance to pre-rectal space.Not only this approach can keep the proper completeness of rectal fascia,but also it maximally reserves the DVF.Here,this article discussed the embryonic origins and anatomic characters of DVF,the structures of neurovascular bundles,dissection in the pre-rectal space,surgical approach and clinical outcomes between DVF and laparoscopic TME.

Laparoscopic inguinal hernia repair,4 445 cases from a single institution / 中华普通外科杂志

Methods The clinical data of 4445 cases (5 530 hernias) who underwent LIHR at Ruijin Hospital from Jan 2001 to Dec 2015 were analyzed retrospectively.2 125 cases underwent 2 402 trans-abdominal preperitoneal procedure(TAPP),2 306 cases did 2 907 totally extraperitoneal (TEP),and 21 IPOMs in 20 cases.There were 3 216 indirect hernias (60.3％),1 164 direct hernias (21.8％),399 recurrent hernias (7.5％),479 complex hernias (9.0％),and 72 femoral hernias (1.4％).The median time of follow-up is 51 months with a range between 7 and 187 months.Results The average operation time was 27.1 ± 8.7 min for unilateral hernia repair,and 43.0 ± 11.0 min for bilateral hernia repair.The average hospital stay was 1.4 ± 1.1 d.There were 250 seroma (4.7％),68 urinary retention (1.3％),23 transient neuropraxia (0.4％) and 3 paralytic obstruction of intestines (0.1％).Severe complications included 1 port site hernia,1 intestinal injury,and 1 mechanical intestinal obstruction.After a medium follow-up of 51 months,there were 13 recurrent cases (0.24％),including 5 cases after TAPP,7 after TEP,1 after IPOM.Conclusion LIHR is a safe and efficient technique for hernia repair.

Clinical efficacy of laparoscopic inguinal hernia repair in elderly patients / 中华消化外科杂志

Objective To explore the clinical efficacy of laparoscopic inguinal hernia repair (LIHR) in elderly patients.Methods The retrospective cohort study was adopted.The clinical data of 3 203 patients with inguinal hernias (3 847 sides) who were adnitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between January 2001 and December 2013 were collected.Of 3 203 patients,979 (1 107 sides) with age ＜ 60 years and 2 224 (2 740 sides) with age ≥ 60 years were respectively allocated into the under 60 years group and 60 years or older group.The surgical procedures including transabdominal preperitoneal (TAPP) approach,total extraperitoneal (TEP) approach and intraperitoneal onlay mesh (IPOM) approach were selected and performed by doctors in the same team.There were light-weight and heavy-weight patches.Observation indicators included (1) overall operation situations,(2) surgical comparison between the 2 groups,(3)comparison of postoperative indicators between the 2 groups,(4) follow-up.Follow-up using telephone interview and outpatient examination was performed to detect the recovery time of non-restricted activity,recurrence of hernia and complications.Measurement data with normal distribution were represented as ~ ± s and comparison between groups was done by the t test.Comparisons of count data were analyzed using the chi-square test or Fisher exact probability.Ranked data were compared by the nonparametric rank sum test.Results (1) Overall operation situations:3 203 patients with inguinal hernias (3 847 sides) underwent LIHR,including 1 475 (1 677 sides) using TAPP approach,1 718 (2 154 sides) using TEP approach and 10 (16 sides) using IPOM approach (6 using TAPP and IOPM approaches in each side).The light-weight patch was used in 2 206 sides and heavy-weight patch was used in 1 641 sides.Operation time was (31 ± 12) minutes in all 3 203 patients,(27 ±9)minutes in 2 559 patients with unilateral hernia and (44 ± 12)minutes in 644 patients with bilateral hernia,respectively.Duration of postoperative hospital stay was (1.5 ± 1.2) days.(2) Surgical comparison between the 2 groups:TAPP approach,TEP approach,IPOM approach,light-weight patch and heavy-weight patch were performed to 567,538,2,751,356 sides in the under 60 years group and 1 110,1 616,14,1 455,1 285 sides in the 60 years or older group,respectively,with statistically significant differences in above indicators between the 2 groups (X2 =37.976,70.022,P ＜ 0.05).Operation time in unilateral hernia and bilateral hernia and total operation time were (27 ± 9)minutes,(42 ± 10)minutes,(29 ± 10)minutes in the under 60 years group and (27 ± 10)minutes,(44 ± 12)minutes,(3 1 ± 13)minutes in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =-0.106,-1.768,-4.445,P ＞ 0.05).(3) Comparison of postoperative indicators between the 2 groups:the pain score at postoperative day 1 and duration of postoperative hospital stay were 2.4 ± 1.1,(1.5 ± 1.1) days in the under 60 years group and 2.3 ± 1.0,(1.5 ± 1.3) days in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (t =1.419,-0.126,P ＞0.05).(4) Follow-up:all the patients were followed up for 23-60 months,with a median time of 43 months.Cases with non-restricted activity recovery at postoperative week 2 and 4 were 973,978 in the under 60 years group and 2 208,2 222 in the 60 years or older group,respectively,showing no statistically significant difference between the 2 groups (X2=0.113,P ＞0.05).The recurrence of hernia,severe complications,serum tumescence,paresthesia and enteroparalysis were detected in 1,0,49,5,1 sides in the under 60 years group and 11,3,132,16,2 sides in the 60 years or older group,respectively,with no statistically significant difference between the 2 groups (x2=1.556,0.269,0.254,P ＞ 0.05).The urinary retention in the under 60 years group and 60 years or older group was respectively detected in 6 and 44 sides,showing a statistically significant difference between 2 groups (x2=6.956,P ＜ 0.05).Conclusion LIHR is safe and effective in elderly patients,and it can achieve good clinical efficacy under selecting reasonable operation procedures and patches.

Comparison study on knee osteoarthritis in rabbits induced by different concentrations of papain / 中国骨伤

<p><b>OBJECTIVE</b>To compare the knee osteoarthritis (OA) models in rabbits by different concentrations of papain and provide data for exploring pathogenesis and treatments of this disease.</p><p><b>METHODS</b>Sixty New Zealand white rabbits were randomly divided into four groups of 15 each and given injections into the right knee on days 1, 3 and 5 including intra-articular injections of 2%, 5% or 10% (w/v) papain and 0.03 mol/L L-cysteine at the dose of 0.1 ml/kg (experimental groups). The 0.9% NaCl (w/v) with a dose of 0.1 ml/kg were injected intra-articularly into the right knees of rabbits in the control group. The rabbits were sacrificed at 2, 4, 6 weeks respectively after the initiation of papain injection and these OA models were evaluated through recording the width of knee joint, performing the morphological observation and histological evaluation of articular cartilage and synovium.</p><p><b>RESULTS</b>The degenerative changes were demonstrated in knee joints of rabbit in all experimental groups, such as thinner articular cartilage, fibrillation and destroyed cartilage matrix, and inflammation, proliferation, and degeneration of the synovial tissue. All these changes were much worse with increased concentration and prolonged observation time.</p><p><b>CONCLUSION</b>Different severity of OA are established through intra-articular injections of 2%, 5% or 10% papain and 0.03 mol/L L-cysteine at the dose of 0.1 ml/kg. These models are of the characters of short period and a good reproducibility.</p>

Therapeutic effect of an injectable sustained-release sinomenine hydrochloride and sodium hyaluronate compound in a rabbit model of osteoarthritis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>While intra-articular injection of sinomenine hydrochloride has a therapeutic effect on osteoarthritis, it has a short half-life, and is thermolabile and photolabile. The aim of this research was to evaluate the sustained-release of sinomenine hydrochloride from an injectable sinomenine hydrochloride and sodium hyaluronate compound (CSSSI) and its therapeutic effect in a rabbit model of osteoarthritis following intra-articular injection.</p><p><b>METHODS</b>An injectable compound consisting of 1% sodium hyaluronate and 2.5% sinomenine hydrochloride was prepared and kept as the experiment group, and 2.5% sinomenine hydrochloride was prepared and kept as the control group. The cumulative mass release was measured at different time points in each group in vitro. Sixty-five male Zelanian rabbits were randomly divided into five groups: 15 (30 knees) each for the control, sodium hyaluronate, sinomenine hydrochloride, and CSSSI groups respectively, and five (10 knees) for the modeling group. Papain was injected into both knees of each rabbit for model establishment. Subsequently, 0.2 ml of the corresponding drugs was injected into the articular cavities of the remaining experiment groups, while the control group was treated with 0.2 ml normal saline. All groups were treated once a week for 4 weeks. Seven days after the last treatment, knees were anatomized to perform pathological observations and Mankin's evaluation of the synovium. Four groups were compared using the SPSS 13.0 software package.</p><p><b>RESULTS</b>In the in vitro sustained-release experiments, 90% of the drug was released in the experiment group 360 minutes following the injection. Comparison of the Mankin's evaluations of the four groups illustrated statistical discrepancies (P < 0.05). In further paired comparisons of the CSSSI group vs. modeling control/sodium hyaluronate/sinomenine hydrochloride groups, statistical significance was uniformly obtained. Moreover, sodium hyaluronate and sinomenine hydrochloride treatments showed significant improvement over the modeling control (P < 0.05), whereas sodium hyaluronate vs. sinomenine hydrochloride comparison failed to reach significance (P > 0.05).</p><p><b>CONCLUSIONS</b>CSSSI has a sustained-release effect on sinomenine hydrochloride. Intra-articular injection of CSSSI was significantly better than the sole sodium hyaluronate or sinomenine hydrochloride for the treatment of osteoarthritis in a rabbit model.</p>

Determination of glycyrrhizic acid in different decoctions of sanaotang by HPLC and comparison with antifugal effects in vitro / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the contents of glycyrrhizic acid in hejian decoction (mixed the traditional Chinese herbs together, then boiling them with water) and the fenjian decoction (boiling the single traditional Chinese herb with water separately, then mixed the abstracts) of Sanaotang (composed of Ephedra sinica, Prunus armeniaca and Glycyrrhiza uralensis) and to compare with their anti-bacterial activities in vitro.</p><p><b>METHOD</b>A HPLC method was established with a Agilent Zorbax SB-C18 column (4. 6 mm x 250 mm, 5 microm), a mobile phase of acetonitrile-0.2% acetic acid solution (35:65), a flow rate of 1 mL x min(-1) and a detection wavelength of 254 nmn in order to determine the contents of glycyrrhizic acid minimal bacterial inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) antagonized the common bacteria in different decoctions were rieasured in vitro by employing dilution method.</p><p><b>RESULT</b>The average content of glycyrrhizic acid of the hejian decoction was higher than that of the fenjian decoction. The hejian decoction could display the inhibitory bactericidal activity to Aeruginosus bacillus, but the fenjian decoction could not. And to Staphylococcus aureus, the inhibitory bactericidal activity the hejian decoction was slightly stronger than that of the fenjian decoction.</p><p><b>CONCLUSION</b>Comparing with that of the fenjian decoction, the content of glycyrrhizic acid of the hejian decoction was higher and the anti-bacterial activities was stronger.</p>

Measurement of baicalin contents by HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To compare the contents of baicalin in the raw medical material and the different prepared medical materials of Scutellaria baicalensis.</p><p><b>METHOD</b>The contents of baicalin were determined by HPLC. Chromatographic conditions included Hypersil C18 column and the mobile phase consisting of a mixture of methanol-0.04% phosphoric acid (46:54). Baicalin was detected at 280 nm. The standard curve was linear in the range of 0.0280-4.6700 micrograms with correlation coefficient 1.0000. The average recovery of baicalin was 101.22% with RSD = 2.54% (n = 5).</p><p><b>RESULT</b>The contents of baicalin were 6.80% in raw material, 6.00% and 6.73% in the different prepared medical materials of S. baicalensis respectively.</p><p><b>CONCLUSION</b>The two different kinds of preparing methods can be used to the raw material of S. baicalensis.</p>