Rhabdomyolysis in adolescents with mental disorders during treatment： two cases report / 四川精神卫生

This article analyzed the laboratory indicators during the clinical diagnosis and treatment of two adolescents with mental disorders who developed rhabdomyolysis during hospitalization， so as to explore the risk of rhabdomyolysis occurring after mild to moderate exercise during treatment for adolescent with mental disorders and to provide references for clinical diagnosis and treatment.

Combination of anlotinib and irinotecan in the second-line treatment of metastatic colorectal cancer: a multicenter phase 1/2 trial / 中华肿瘤杂志

Objective: To evaluate the safety and efficacy of anlotinib plus irinotecan in the second-line treatment of patients with metastatic colorectal cancer (mCRC). Methods: This prospective phase 1/2 study was conducted in 2 centers in China (Cancer Hospital of Chinese Academy of Medical Sciences and Jiangsu Province Hospital). We enrolled patients with mCRC whose disease had progressed after first-line systemic therapy and had not previously treated with irinotecan to receive anlotinib plus irinotecan. In the phase 1 of the trial, patients received anlotinib (8 mg, 10 mg or 12 mg, po, 2 weeks on/1 week off) in combination with fixed-dose irinotecan (180 mg/m(2), iv, q2w) to define the maximum tolerated dose (MTD) and recommended phase 2 dose (RP2D). In the phase 2, patients were treated with the RP2D of anlotinib and irinotecan. The primary endpoints were MTD and objective response rate (ORR). Results: From May 2018 to January 2020, a total of 31 patients with mCRC were enrolled. Anlotinib was well tolerated in combination with irinotecan with no MTD identified in the phase 1, and the RP2D was 12 mg. Thirty patients were evaluable for efficacy analysis. Eight patients achieved partial response, and 21 had stable disease, 1 had progressive disease. The ORR was 25.8% and the disease control rate was 93.5%. With a median follow-up duration of 29.5 months, the median progression-free survival and overall survival were 6.9 months (95% CI: 3.7, 9.3) and 17.6 months (95% CI: 12.4, not evaluated), respectively. The most common grade 3 treatment-related adverse events (≥10%) were neutropenia (25.8%) and diarrhea (16.1%). There was no treatment-related death. Conclusion: The combination of anlotinib and irinotecan has promising anti-tumor activity in the second-line treatment of mCRC with a manageable safety profile.

Observation on clinical effect of fire needling for mild to moderate benign prostatic hyperplasia with kidney yang deficiency / 中国针灸

OBJECTIVE@#To observe the effect of fire needling on prostate symptoms, quality of life, average daily number of nightly urination, urine flow rate and prostat volume in patients with mild to moderate benign prostatic hyperplasia (BPH) of kidney yang deficiency.@*METHODS@#A total of 60 patients with mild to moderate BPH of kidney yang deficiency were randomly divided into an observation group (30 cases, 3 cases dropped off) and a control group (30 cases, 4 cases dropped off). The observation group was treated with fire needling at Guanyuan (CV 4), Shuidao (ST 28) and Qugu (CV 2) twice a week (2-3 d interval between each treatment), continuous treatment for 4 weeks. The control group received lifestyle advice and education, once a week for 4 weeks. In the two groups, the international prostate symptom score (IPSS), the quality of life (QoL) score and the average daily number of nightly urination were observed before treatment, after treatment and during the follow-up of the 4th week; the urinary maximum flow rate (Qmax), the average flow rate (Qave), and the prostate volume were assessed before and after treatment in the two groups. The safety was observed in the observation group.@*RESULTS@#After treatment and during follow-up, the IPSS scores, QoL scores, and the average daily number of nightly urination in the observation group were decreased compared with those before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, there was no significant difference in Qmax, Qave and prostate volume between the two groups and within the each group (P>0.05). There were no fire needling-related adverse reactions, and no obvious abnormality was found in urine routine and coagulation function tests before and after treatment in the observation group.@*CONCLUSION@#Fire needling can improve lower urinary tract symptoms and quality of life, reduce frequency of nightly urination in patients with mild to moderate BPH of kidney yang deficiency, and has good safety.

GE Signa HDxt 1.5 T MRI PAC Module Troubleshooting and Repair / 中国医疗器械杂志

Through the analysis of PAC module faults in two GE Signa HDxt 1.5 T MRI cases, the fault performance was analyzed. According to the working principle of PAC module, the fault was analyzed and processed, and then the suspicious fault parts were located and repaired to make the equipment run normally. Finally, the operating principles of PAC module in terms of power supply, signal transmission and data transmission were summarized to facilitate the subsequent quickly and find out fault points for maintenance accurately.

Application of "eliminating stagnation and bloodletting/fire needling" in treatment of jingjin diseases / 中国针灸

Based on the development of conditions, the etiology and pathogenesis of jingjin (muscle region of meridian) diseases are summarized as 3 stages, i.e. stagnation due to over-exertion at early stage, manifested by tendon-muscle contracture and tenderness; cold condition due to stagnation, interaction of stasis and cold, resulting in clustered nodules at the middle stage; prolonged illness and missed/delayed treatment, leading to tendon-muscle contracture and impairment of joint function at the late stage. It is proposed that the treatment of jingjin diseases should be combined with the characteristic advantages of fire needling and bloodletting technique, on the base of "eliminating stagnation and bloodletting/fire needling". This combined therapy warming yang to resolve stasis and dispels cold to remove nodules, in which, eliminating the stagnation is conductive to the tissue regeneration, and the staging treatment is delivered in terms of the condition development at different phases.

Efficacy of thunder-fire moxibustion plus glucosamine sulfate potassium capsule in treating knee osteoarthritis: a clinical trial / 国际中医中药杂志

Objective:To evaluate the clinical efficacy of thunder-fire moxibustion plus glucosamine sulfate potassium capsule in treating knee osteoarthritis (KOA).Methods:This study was a randomized controlled trial. A total of 90 participants with KOA in the Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University from February 2020 to December 2021 were randomized and assigned into 3 groups, with 30 cases in each group according to the random number table method. The thunder-fire moxibustion group was only treated with thunder-fire moxibustion on Neixiyan and Dubi acupoints, while the medication group was only treated with oral glucosamine sulfate potassium capsule, and the thunder-fire moxibustion plus medication group was treated with thunder-fire moxibustion on Neixiyan and Dubi acupoints combined with oral glucosamine sulfate potassium capsule. All the three groups were treated for 4 weeks. The degree of joint pain and stiffness was assessed using the Western Ontario and McMaster Universities osteoarthritis index (WOMAC); the amount of knee joint cavity effusion was detected by ultrasound; the knee circumference was measured to assess the degree of knee swelling.Results:After treatment, the amount of knee joint cavity effusion [(3.21±2.44) mm, (3.73±2.53) mm vs. (4.80±3.07) mm, F=6.82], the WOMAC score [(65.88±30.25), (77.74±28.27) vs. (86.58±31.50), F=7.92], knee circumference [(36.74±2.74) cm, (37.59±2.63) cm vs. (38.51±3.09) cm, F=8.94] in the thunder-fire moxibustion plus medication group and the thunder-fire moxibustion group were lower than those in the medication group ( P<0.01). Conclusion:Thunder-fire moxibustion plus oral glucosamine sulfate potassium capsule can reduce the amount of knee joint cavity effusion, WOMAC score and the degree of knee swelling, and the efficacy is better than thunder -fire moxibustion and oral glucosamine sulfate potassium capsule.

Simultaneous determination of five components in Anemarrhenae Rhizoma by HPLC-ELSD / 药学实践杂志

Objective To establish a method for the simultaneous determination of new mangiferin, mangiferin, artemisinin BⅡ, icariin and artemisinin A in Anemarrhenae Rhizoma by high performance liquid chromatography-evaporation light scattering detector (HPLC-ELSD). Methods The column was Agilent Poroshell 120 EC-C18. The mobile phase used acetonitrile-0.2% acetic acid water system with gradient elution. Column temperature was 30 ℃. Flow rate was 0.7 ml/min. Evaporative light scattering detector used nitrogen as atomizing gas. The atomizing gas temperature was 40 ℃ and the drift tube temperature was 90 ℃. The nitrogen volume flow rate was 2.00 L/min and the sample volume was 20 μl. Results The five components were able to achieve baseline separation. Neomangiferin, Mangiferin, Anemaponin BⅡ, Baohuoside I , Anemarrhena saponin AⅢwere determined as 24.1-386 μg/ml (r=0.999 3), 23.2-371 μg/ml (r=0.998 6), 54.2-867.2 μg/ml(r=0.995 6), 5.3-84.8 μg/ml (r=0.996 8), 10-160 μg/ml (r=0.998 9) respectively, which showed a good linear relationship within the concentration range. The average recovery rate of the five components was between 101.8% and 105.0%, and the repeatability RSD was less than 2.4%. The content of the above five components in Zhimu medicinal materials were 1.62%, 0.82%, 7.36%, 0.07%, 0.34%, respectively. Conclusion The method is simple, accurate, and highly sensitive, which could be used as the quantitative determination of multiple index components of Anemarrhenae Rhizoma.

A new classification on location of hepatolithiasis in guiding treatment with percutaneous transhepatic choledochoscopic lithotripsy / 中华肝胆外科杂志

Objective:To study the clinical application of a new classification on location of hepatolithiasis in guiding treatment using percutaneous transhepatic choledochoscopic lithotomy (PTCSL).Methods:The clinical data of 85 consecutive patients with preoperatively diagnosed hepatolithiasis who underwent PTCSL at the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were prospectively collected. There were 27 males and 58 females, aged from 15 to 86(62±14) years. Hepatolithiasis was classified into five types of stone location based on preoperative imagings: type Ⅰ ( n=12) , stones located in central bile duct, including hilar bile duct and common hepatic duct; type Ⅱ ( n=17) in unilateral hepatic duct with multiple branches; type Ⅲ ( n=24) in unilateral hepatic duct with multiple branches plus central bile duct; type Ⅳ ( n=31) in bilateral hepatic ducts with multiple branches; and type Ⅴ ( n=1) in unilateral hepatic duct with a single branch. Fistulation path, number of procedures, number of bile duct fistula, and complications were recorded. The residual stone rate and stone recurrence rate were compared among the five types. The follow-up was performed to analyse prognosis. Results:A total of 99 biliary fistulae were performed, with one single tract created in 74 patients, two tracts in 9 patients, three tracts in 1 patient, and four tracts in 1 patient. The fistulation path was B2 in 12 patients, B3 in 18 patients, B4 in 1 patient, B5 in 4 patients, B6 in 10 patients, B7 in 4 patients, and B8 in 50 patients. Altogether, 151 choledochoscopic lithotomy procedures were performed (1-3 times per patient, mean 1.78 times). For the 9 patients with residual stones (10.6%, 9/85), there were 3 patients with type Ⅱ and 6 patients with type Ⅳ. There were significant differences in the residual stone rates among the 5 types (χ 2=11.13, P=0.025). Stone recurrence developed in 33 (38.8%) patients, including 2 patients with type Ⅰ, 7 patients with type Ⅱ, 10 patients with type Ⅲ and 14 patients with type Ⅳ (χ 2=9.07, P=0.046). The total intraoperative and postoperative complications rates was 28.2% (24/85). The follow-up period was 4-58 months with the median follow-up time of 30 months. Twelve patients died during the follow-up period, including 1 patient who died from postoperative bleeding, 3 cholangiocarcinoma, 7 biliary cirrhosis-related liver failure, and 1 stone-unrelated disease. Conclusion:Type Ⅳ in the location classification of hepatolithiasis based on PTCSL had significantly higher rates of residual stones and stone recurrence. This new classification is helpful for clinicaians to determine the optimal path using a smaller number of fistulation tracts to clear stones. It improved the efficacy of PTCSL in treating hepatolithiasis.

Effect of Weiwei Tongtiao Decoction on Expression of IKKβ, Bcl-2 in CAG Precancerous Lesion Rats / 中国实验方剂学杂志

Objective:To investigate the effect of Weiwei Tongtiao decoction on gastric mucosal pathology and the expression level of inhibitor kappa B kinase <italic>β</italic>（IKK<italic>β</italic>） and B-cell lymphoma-2（Bcl-2）in rats with chronic atrophic gastritis （CAG） precancerous lesion. Method:SD rats were randomly divided into normal group， model group， positive drug Weifuchun group， Weiwei Tongtiao decoction high， medium and low dose treatment groups. The rat model of CAG precancerous lesion was prepared by <italic>N</italic>-methyl-<italic>N</italic>'-nitro-<italic>N</italic>-nitrosoguanidine （MNNG）compound modeling method. weiwei Tongtiao decoction high， medium and low dose treatment groups received intragastric administration of 24， 12， 6 g·kg^-1 Weiwei Tongtiao decoction respectively， while Weifuchun group received 0.45 g·kg^-1 Weifuchun suspension， once per day for 12 weeks. The pathological changes of gastric mucosa of rats were observed by hematoxylin-eosin（HE）staining， and the mRNA and protein levels of IKK<italic>β</italic> and Bcl-2 in gastric mucosa of rats were detected by Real-time quantitative polymerase chain reaction （Real-time PCR）， immunohistochemistry（IHC）and Western blot. Result:Compared with the normal group， 100% inherent gland atrophy， mild to severe intestinal metaplasia， and 25% low-grade intraepithelial neoplasia were observed under microscope in model group. All Weifuchun group and Weiwei Tongtiao decoction groups could improve the atrophy of gastric glands， moderate to severe intestinal metaplasia and pathological injury of low-grade intraepithelial neoplasia， especially at high dose group. Compared with the normal group， IKK<italic>β</italic>， Bcl-2 mRNA and protein expressions in the gastric mucosa of the model group were up-regulated （<italic>P</italic><0.01）. Compared with the model group， the mRNA and protein expressions of IKK<italic>β</italic> and Bcl-2 in gastric mucosa of rats in the Weifuchun group and the Weiwei Tongtiao decoction high， medium and low dose groups were down-regulated （<italic>P</italic><0.05，<italic>P</italic><0.01）， showing a dose-dependent relationship， and such levels in the Weiwei Tongtiao decoction high-dose intervention group were similar to those in normal group. Conclusion:Weiwei Tongtiao decoction can improve and even reverse gastric mucosa with CAG precancerous lesions in rats， and its intervention mechanism may be related to down-regulating the expressions of IKK<italic>β</italic> and Bcl-2 in gastric mucosa.

Network pharmacological analysis and experimental verification of anti-inflammatory and analgesic effect of Zanthoxyli Pericarpium / 中国中药杂志

To explore the mechanism of anti-inflammatory and analgesic effect of Zanthoxyli Pericarpium based on network pharmacology and inflammatory or pain mouse models. The effective components of Zanthoxyli Pericarpium were screened out by TCMSP database. And their potential corresponding targets were predicted by PharmMapper software. The possible targets relating to inflammation and pain were mainly collected through DrugBank, TTD and DisGeNET databases. The "active ingredient-gene-disease" network diagram was constructed by Cytoscape 3.7.0 software. The network pharmacology results showed 5 potential effective compounds, which were related to 29 targets; 132 targets relating to inflammation and pain were screened out in the DrugBank, TTD and DisGeNET databases. The network analysis results indicated that the phosphatidylinositol 3-kinase catalytic subunit gamma isoform(PIK3 CG) gene may be the key to the anti-inflammatory and analgesic effect of Zanthoxyli Pericarpium. The anti-inflammatory and analgesic effects of essential oil extract and dichloromethane extract of Zanthoxyli Pericarpium were explored through the mouse model of inflammation induced by xylene or carrageenan and the mouse model of pain induced by acetic acid or formalin. The experimental results showed that essential oil extract and dichloromethane extract of Zanthoxyli Pericarpium could reduce xylene-induced ear swelling and carrageenan-induced paw swelling and decrease the number of writhing responses in mice induced by acetic acid and the licking foot time of mice in phase Ⅱ induced by formalin. Western blot results showed that Zanthoxyli Pericarpium extract could inhibit the expressions of PIK3 CG, phosphonated nuclear factor kappaB(p-NF-κB) and phosphonated p38(p-p38 MAPK) protein. The present study showed the anti-inflammatory and analgesic effect of Zanthoxyli Pericarpium through multiple components and targets, so as to provide a pharmacodynamic basis for the study of Zanthoxyli Pericarpium and its mechanism.

Cut-off values of lesion and vessel quantitative flow ratio in de novo coronary lesion post-drug-coated balloon therapy predicting vessel restenosis at mid-term follow-up / 中华医学杂志(英文版)

BACKGROUND@#Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up.@*METHODS@#The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student's t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC).@*RESULTS@#A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001).@*CONCLUSIONS@#The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.

The clinical role of ultrasound image-fusion navigation system in percutaneous transhepatic cholangioscopic lithotripsy / 中华肝胆外科杂志

Objective:To study the clinical role of ultrasound image-fusion and navigation system (UIFNS), which works through image fusion with volume navigation of ultrasound (VNUS) and computed tomography (CT) or magnetic resonance imaging (MRI), in percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for treatment of hepatolithiasis.Methods:The data of 54 patients with hepatolithiasis who underwent PTCSL between January 2017 and October 2019 in Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University was retrospectively analyzed. Among 54 patients, 16 males and 38 females, aged 16-84 years with a median age of 59.5 years, were included. Preoperative ultrasound, CT, MRI and UIFNS were used to evaluate stone location and distribution in bile ducts. The rates of consistency of each single modality of evaluation with intraoperative examination by cholangioscopy plus ultrasound were compared. The stone clearance rates were compared among the different groups with different numbers of biliary sinus tracts used for stone extraction.Results:The rates of consistency of each single modality of evaluation, including ultrasound, CT, MRI and UIFNS, with intraoperative examination by choledochoscopy plus ultrasound were 75.9% (41/54), 55.6% (30/54), 72.2% (39/54) and 92.6% (50/54), respectively. The rates of consistency as assessed by UIFNS was significantly higher than that by CT or MRI (each P<0.05). The 54 patients were divided into the central-type group, the single-biliary-branch-type group and the multi-branch-type group according to biliary stone location and distribution, with 10 patients, 2 patients and 42 patients, respectively. Biliary sinus tract was established by the one-step method. One single tract was established in 43 patients, and two or more tracts in 11 patients. Each patient underwent 1-3 times of cholangioscopic lithotripsy (mean 1.76 times). The stone clearance rate in the central-type of patients and patients with single-biliary-branch stones was 100% (12/12). In 42 patients with stones in multiple branches of intrahepatic bile ducts, 31 patients underwent stone extraction through a single sinus tract while 11 patients through 2 or more sinus tracts. There was no significant difference in the stone clearance rate between patients with a single sinus tract and those with 2 or more sinus tracts ( P>0.05). The total stone clearance rate was 79.6% (43/54) and the total complication rate 18.5% (10/54). Conclusion:UIFNS was a useful tool with advantages in evaluating the location and distribution of biliary stones, and in selecting appropriate hepatic ducts for planning puncture routes to establish sinus tracts for stone removal.

Clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one-step biliary fistulation for the treatment of hepatolithiasis / 中华消化外科杂志

Objective:To investigate the clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one-step biliary fistulation (PTCSL-OBF) for the treatment of hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 59 patients with hepatolithiasis who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2017 to December 2019 were collected. There were 16 males and 43 females, aged from 16 to 84 years, with a median age of 60 years. All patients underwent PTCSL-OBF. Observation indicators: (1) surgical and postoperative situations; (2) follow-up; (3) introduction of special cases. Follow-up using outpatient examination and telephone interview was performed to detect the hepotolithiasis-related symptoms, recurrence of hepatolithiasis , and survival of patients up to December 2019. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages. Results:(1) Surgical and postoperative situations: 59 patients underwent PTCSL-OBF successfully. Of the 59 patients, 48 cases had 1 biliary sinus tract, 8 cases had 2 biliary sinus tracts, 2 cases had 3 biliary sinus tracts and 1 case had 4 biliary sinus tracts. A total of 106 times of cholangioscopic lithotripsy procedure were performed in the 59 patients, including 20 cases with once of cholangioscopic lithotripsy procedure, 31 cases with twice of cholangioscopic lithotripsy procedure and 8 cases with 3 times of cholangioscopic lithotripsy procedure. Among the 59 patients, 14 cases were diagnosed with residual stones after operation, 45 cases had stones removed completely with the stones removal rate of 76.3%(45/59). The duration of hospital stay of the 59 patients were 24 days(range, 3-88 days). Of the 59 patients, 11 cases had 14 times of postoperative complications. The total incidence of complications was 18.6%(11/59). Among the 14 times of complications, there were 4 times of pleural effusion combined with infection, 2 times of liver abscess, 2 times of ascites, 2 times of intraoperative hypotension septic shock, 2 times of bleeding, 1 time of colon perforation and 1 time of bile leakage. Patients with complications were cured with symptomatic support treatment including puncture drainage, anti-infection and hemostasis. (2) Follow-up: 59 patients were followed up for 1-34 months, with a median follow-up time of 18 months. Of the 59 patients, 9 had recurrence of hepatolithiasis, with a recurrence rate of 15.3%(9/59); 17 had hepatolithiasis related symptoms, with an incidence of 28.8%(17/59). Of the 45 patients who had stones removed completely, 6 had recurrence of hepatolithiasis, with a recurrence rate of 13.3%(6/45); 14 had hepatolithiasis related symptoms, with an incidence rate of 31.1%(14/45). Of the 14 patients who had residual stones postoperatively, 3 had recurrence of hepatolithiasis, with an incidence rate of 21.4%(3/14); 3 had hepatolithiasis related symptoms, with an incidence rate of 21.4%(3/14). During the follow-up, 7 of 59 patients died, 2 of whom died of biliary neoplasms and 5 died of decompensated cirrhosis. (3) Introduction of special cases: among the 5 patients with biliary cirrhosis, 3 cases had stones removed completely, but the original symptoms of the 2 cases were not improved postoperatively and cholangitis occurred repeatedly. The other 2 cases underwent only once of cholangioscopic lithotripsy procedure because of severe cirrhosis combine with massive ascites.Conclusion:PTCSL-OBF can be used in the treatment of hepatolithiasis with appropriate indications, careful operation and strengthened perioperative management to reduce complications.

Intensive statin versus low-dose statin + ezetimibe treatment for fibrous cap thickness of coronary vulnerable plaques / 中华医学杂志(英文版)

BACKGROUND@#Acute coronary syndromes mainly result from abrupt thrombotic occlusion caused by atherosclerotic vulnerable plaques (VPs) that suddenly rupture or erosion. Fibrous cap thickness (FCT) is a major determinant of the propensity of a VP to rupture and is recognized as a key factor. The intensive use of statins is known to have the ability to increase FCT; however, there is a risk of additional adverse effects. However, lower dose statin with ezetimibe is known to be tolerable by patients. The present study aimed to investigate the effect of intensive statin vs. low-dose stain + ezetimibe therapy on FCT, as evaluated using optical coherence tomography.@*METHOD@#Patients who had VPs (minimum FCT 90°) and deferred from intervention in our single center from January 2014 to December 2018 were included in the trial. They were divided into the following two groups: intensive statin group (rosuvastatin 15-20 mg or atorvastatin 30-40 mg) and combination therapy group (rosuvastatin 5-10 mg or atorvastatin 10-20 mg + ezetimibe 10 mg). At the 12-month follow-up, we compared the change in the FCT (ΔFCT%) between the two groups and analyzed the association of ΔFCT% with risk factors. Fisher exact test was used for all categorical variables. Student's t test or Mann-Whitney U-test was used for analyzing the continuous data. The relationship between ΔFCT% and risk factors was analyzed using linear regression analysis.@*RESULT@#Total 53 patients were finally enrolled, including 26 patients who were in the intensive statin group and 27 who were in the combination therapy group. At the 12-month follow-up, the serum levels of total cholesterol (TC), total triglyceride, low-density lipoprotein (LDL-C), hypersensitive C-reactive protein (hs-CRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels were reduced in both the groups. The ΔTC%, ΔLDL-C%, and ΔLp-PLA2% were decreased further in the combination therapy group. FCT was increased in both the groups (combination treatment group vs. intensive statin group: 128.89 ± 7.64 vs. 110.19 ± 7.00 μm, t = -9.282, P < 0.001) at the 12-month follow-up. The increase in ΔFCT% was more in the combination therapy group (123.46% ± 14.05% vs. 91.14% ± 11.68%, t = -9.085, P < 0.001). Based on the multivariate linear regression analysis, only the serum Lp-PLA2 at the 12-month follow-up (B = -0.203, t = -2.701, P = 0.010), ΔTC% (B = -0.573, t = -2.048, P = 0.046), and Δhs-CRP% (B = -0.302, t = -2.963, P = 0.005) showed an independent association with ΔFCT%.@*CONCLUSIONS@#Low-dose statin combined with ezetimibe therapy maybe provide a profound and significant increase in FCT as compared to intensive statin monotherapy. The reductions in Lp-PLA2, ΔTC%, and Δhs-CRP% are independently associated with an increase in FCT.

Value of index of microcirculatory resistance for early prediction of periprocedural myocardial microcirculatory injury after percutaneous coronary intervention in patients with coronary heart disease / 中华心血管病杂志

Objective@#To explore the value of index of microcirculatory resistance (IMR) for early prediction of periprocedural myocardial injury (PMI) in patients with stable angina pectoris (SAP) and acute coronary syndrome (ACS) after PCI.@*Methods@#It was a prospective study. One hundred and sixty-four patients who had single coronary lesion were consecutively enrolled from May 2014 to December 2017 at Nanjing Hospital affiliated to Nanjing Medical University. According to clinical manifestation, patients were divided into SAP group (n=81) and ACS group (n=83). IMR was determined by thermal dilution with pressure guide wire. Basic clinical characteristics, coronary angiographic results, PCI procedural details, IMR after PCI, ΔIMR (IMR=post-PCI-IMR pre-PCI), levels of myocardial biomarkers before and after PCI were compared between the two groups. Multivariate logistic regression was used to analyze the relation of PMI with IMR and ΔIMR, and the predictive ability was evaluated by receiver operating characteristic (ROC).@*Results@#The levels of total cholesterol and low density lipoprotein cholesterol were significantly higher in ACS group than in SAP group (P<0.05), other clinical data at baseline were similar between the two groups (P>0.05). Quantitative coronary angiography (QCA) results and PCI related data were also similar between the two groups before PCI (P>0.05). Values of mean transit time (Tmn) of intracoronary injection with room temperature saline, post-PCI IMR and ΔIMR were significantly higher in ACS group than in SAP group after PCI (P<0.05). Plasma creatine kinase isoenzyme-MB difference (ΔCK-MB) (ΔCK-MB=CK-MB post-PCI-CK-MB pre-PCI) and cardiac troponin-I (cTnI) difference (ΔcTnI=cTnI post-PCI-cTnI pre-PCI) were significantly larger in ACS group than in SAP group (P<0.05). Multivariate logistic regression analysis showed that coronary artery disease (CHD) type (SAP and ACS) (OR=1.301, 95%CI 1.083-1.562), age (OR=1.007, 95%CI 1.000-1.013), ΔIMR (OR=1.009, 95%CI 1.000-1.017) and post-PCI IMR (OR=1.008, 95%CI 1.001-1.014) were independent predictors of PMI (P<0.05). The area under the ROC curve (AUC) of ΔIMR was 0.763 to predict PMI (P<0.05), the optimum cut-off value of ΔIMR was 5.485 with 70.0% sensitivity and 77.4% specificity. ΔIMR was positively correlated with ΔcTnI (r=0.592, P<0.05).@*Conclusions@#ΔIMR serves as an early predictor of PMI in CHD patients after PCI. As compared with SAP patients, ACS patients are more likely to develop PMI.

Effect of group attribution training combined with clozapine on negative symptoms and quality of life in refractory schizophrenia patients / 中华行为医学与脑科学杂志

Objective To investigate the effect of attributional retraining group therapy ( ARGT) combined with closabine on the negative symptoms and quality of life in refractory schizophrenia patients. Methods The refractory schizophrenia patients were divided into ARGT combined with clozapine therapy group(study group,n=56) and clozapine alone group(control group,n=54). The positive and negative syn-drome scale( PANSS) was used to assess the symptoms of all patients at baseline and 8 weeks later. The quality of life(QOL) of the patients was assessed by GQOLI-74 at baseline and 8 weeks after treatment. The side effects were evaluated by treatment emergent symptom scale(TESS) before and after treatment. SPSS18. 0 was used for statistical analysis. Results At baseline,there was no significant difference in PANSS score between the two groups. After 8 weeks,the total score of PANSS (79. 41±11. 64) and the score of negative symptoms (28. 68 ±2. 74) in the study group were lower that those of control group(83. 06±11. 58,30. 61± 2. 12),and the differences were statistically significant(t=7. 68,7. 10,both P<0. 05). The scores of positive symptoms,cognitive symptoms,emotional symptoms and aggression symptoms in the study group had no sta- tistical differences compared with the control group (all P>0. 05). There were no significant differences in the scores of material life,mental health,physical health and social function between the two groups at base-line (P>0. 05). After 8 weeks,the total score of GQOLI- 74 (206. 37±14. 37),material life score (48. 69± 6. 35),body health score ( 52. 83± 7. 32),mental health score ( 51. 66 ± 4. 63) and social function score (53. 62± 6. 17) of the study group were higher than those of control group((182. 00± 12. 56),( 44. 62± 6. 11),(48. 52±5. 52),(45. 26±4. 66),(46. 18±5. 32))(t=4. 67,5. 26,3. 26,4. 92,3. 25,all P<0. 05). There was no significant difference in TESS score between the two groups(P<0. 05). Conclusion ARGT combined with clozapine can improve the negative symptoms and the quality of life of patients with refractory schizophrenia.

Neuroprotective Effects of Electroacupuncture Preventive Treatment in Senescence-Accelerated Mouse Prone 8 Mice / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the preventive treatment effects of electroacupuncture (EA) on cognitive changes and brain damage in senescence-accelerated mouse prone 8 (SAMP8) mice.</p><p><b>METHODS</b>The 5-month-old male SAMP8 and age-matched homologous normal aging mice (SAMR1) were adopted in this study. EA stimulation at Baihui (GV 20) and Yintang (EX-HN 3) was performed every other day for 12 weeks, 4 weeks as a course. Morris water maze test and Nissl-stained with cresyl violet were used for cognitive impairments evaluation and brain morphometric analysis. Amyloid-β (A β) expression in hippocampus and parietal cortex was detected by immunohistochemistry, and apoptosis was observed by TUNEL staining.</p><p><b>RESULTS</b>After 3 courses of EA preventive treatment, the escape latencies of 8-month-old SAMP8 mice in EA group were significantly shortened than those of un-pretreated SAMP8 mice. Compared with SAMR1 mice, extensive neuronal changes were visualized in the CA1 area of hippocampus in SAMP8 mice, while these pathological changes and attenuate cell loss in hippocampal CA1 area of SAMP8 mice markedly reduced after EA preventive treatment. Furthermore, A β expression in hippocampus and parietal cortex of SAMP8 mice decreased significantly after EA treatment, and neuronal apoptosis decreased as well.</p><p><b>CONCLUSION</b>EA preventive treatment at GV 20 and EX-HN 3 might improve cognitive deficits and neuropathological changes in SAMP8 mice, which might be, at least in part, due to the effects of reducing brain neuronal damage, decreasing neuronal apoptosis and inhibiting A β-containing aggregates.</p>

Characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection in young female patients / 中华心血管病杂志

Objective@#To investigate the characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection(SCAD) in young female patients. @*Methods@#In this casecontrolstudy,127 young(≤55 years) female patients with acute myocardial infarction onset within 1 week in Nanjing first hospital, Xuzhou central hospital, affiliated hospital of Xuzhou medical university, and Lianyungang first people's hospital were enrolled between January 2013 and February 2017,and the clinical data were retrospectively analyzed. According to their clinical manifestations and coronary angiography(CAG) results,the patients were divided into coronary atherosclerosis disease(CAD) group(CAG evidenced atherosclerosis, n=83) and SCAD group(CAG detected coronary artery dissection,n=44).The SCAD patients were subdivided into definite group (the results affirmed from intravenous ultrasound or optical coherence tomography, n=21) and probable group (the CAG results highly confirmed to characteristics of SCAD,but no intravenous ultrasound or optical coherence tomography image affirmation,n=23). Then, according to the different treatment strategies, the SCAD patients were subdivided into conservative treatment group(treated with drugs,n=19) and interventional therapy group(treated with percutaneous coronary intervention,n=25). @*Results@#(1)Compared to CAD group, patients in the SCAD group had less risk factors, such as hypertension history (25.0% (11/44) vs. 45.8% (38/83) , P=0.022) and diabetes history (6.8% (3/44) vs. 21.7% (18/83) , P=0.043),and had lower levels of fasting blood glucose (5.34(4.59,5.87) mmol/L vs. 7.12(5.18,8.60)mmol/L, P=0.001),total cholesterol((3.94±1.14) mmol/L vs. (4.91±1.50) mmol/L, P=0.001),triglyceride(1.42 (0.91,1.64) mmol/L vs. 1.89 (1.23,2.45) mmol/L, P=0.005),and low density lipoprotein cholesterol ((2.24±0.91) mmol/L vs. (2.94±1.16) mmol/L, P=0.001),CAG results showed that patients in the SCAD group had more single vessel lesion (88.6% (39/44) vs. 39.8% (33/83) , P=0.001), and their target lesion stenosis was less severe ( (79.2±22.4) % vs. (91.5±12.1) %, P=0.001). (2) The clinical risk factors such as hypertension history, diabetes history, smoking history, family history of cardiology disease, fasting blood glucose,total cholesterol,triglyceride and low density lipoprotein cholesterol were similar between definite group and probable group (all P>0.05). CAG results showed that prevalence of single vessel lesion (100% (21/21) vs. 78.3% (18/23) , P=0.050) and percent of target lesion stenosis ( (76.9±20.6) % vs. (81.2±24.1) %, P=0.529) were similar between definite group and probable group.(3)There were no significant difference in single vessel(84.0% (21/25) vs. 94.7% (18/19) , P=0.370), target lesion stenosis(85.0(70.0,100.0)% vs. 75.0(50.0,90.0)%, P=0.186),and survival rates in hospital(96.0% (24/25) vs. 100% (19/19) , P=1.000) between interventional therapy group and conservative treatment group.@*Conclusions@#Prevalence of SCAD is highin young female patients with acute myocardial infarction. Acute myocardial infarction patients with less risk factors of CAD and with CAG showing smooth lesion of narrowing segment and normal finding in the other vessels, are more likely to be diagnosed with SCAD.Acute myocardial infarction patients caused by SCAD have high survival rate either receiving percutaneous coronary intervention or drug treatment.

The progresses of molecular mechanism of Isoniazid resistance in Mycobacterium Tuberculosis / 医学研究生学报

Mycobacterium tuberculosis is the causative agent of tuberculosis, which is a threat to public health worldwide. Isoniazid is one of the most active compounds used to treat tuberculosis worldwide. The pro-drug isoniazid is activated by catalase-peroxidase (KatG), and the active isoniazid products are targeted to InhA. The molecular mechanisms of isoniazid resistance involve several genes mutations. Mutation in the katG gene is the major cause for isoniazid resistance, followed by inhA, kasA, oxyR . Efflux pump systems also play important role in conferring isoniazid resistance. Understanding the mechanisms operating behind isoniazid action and resistance would enable better diagnosis and treatment of isoniazid-resistant tuberculosis.

Spontaneous Coronary Artery Dissection as a Cause of Acute Myocardial Infarction in Young Female Population: A Single-center Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic but a rare and extremely dangerous clinical entity, it has a high prevalence in young female population with acute myocardial infarction (AMI). The previous reports were restricted to other countries' population, but rare in China. Hence, this study aimed to focus on the characteristics of SCAD as a cause of young female AMI population in Jiangsu, China.</p><p><b>METHODS</b>This study enrolled young female AMI patients aged ≤50 years who underwent coronary angiography (CAG) and intracoronary imaging in our center between January 2013 and December 2016. Their clinical presentations, risk factors, and CAG characteristics were analyzed.</p><p><b>RESULTS</b>A total of 60 young female AMI (<7 days) patients were enrolled. From their CAG and intracoronary imaging results, the prevalence of SCAD in young female AMI population was 35% (21/60), the prevalence of coronary atherosclerostic heart disease was 65% (39/60). In the SCAD group, 43% (9/21) presented with non-ST-elevation myocardial infarction (NSTEMI) and the remainder presenting as STEMI. SCAD usually occurred in a single vessel (20/21, 95%), especially in left anterior descending artery (14/21, 67%). Eighteen patients (18/21, 86%) underwent conservative treatment, whereas the remaining three patients (3/21, 14%) underwent percutaneous coronary intervention. Regarding the angiographic results of SCAD lesions, intramural hematoma was discriminated in 95% (20/21), and Type I imaging was observed in 5% (1/21), Type II was observed in 67% (14/21), and Type III was 29% (6/21). The average stenosis in the group was 76.9% ± 20.6%, and the mean lesion length was 36.6 ± 8.6 mm.</p><p><b>CONCLUSIONS</b>SCAD has a high prevalence in young female AMI population in Jiangsu, China. Discriminating the cause of AMI in young female population is very important.</p>