Exploration and practice of artificial intelligence assisted primary vision health management / 中华预防医学杂志

It has attracted much attention worldwide that the application of artificial intelligence (AI) in primary screening and clinical diagnosis and treatment of eye diseases. In recent years, this technology has also been widely used in various grass-roots eye disease management, effectively improving the current situation of weak eye disease diagnosis ability and shortage of human resources in primary medical institutions. At present, there is no reference standard or guideline for the management mode, implementation content and management method of vision health management based on this technology, which are in urgent need of standardization. The article described the work mode exploration of AI-assisted grass-roots visual health management in Shanghai and shared practical experience. The aim is to provide reference for other provinces in China to carry out relevant work.

Analysis of community intervention effects for diabetic eye diseases in Shanghai Xinjing community from 2016 to 2018 / 中华预防医学杂志

Objective: To analyze the effects of community-based interventions for diabetic eye diseases in Xinjing community, Shanghai from 2016 to 2018. Methods: Based on the project of "Establishment of Service Model for Comprehensive Prevention and Treatment of Diabetic Eye Diseases in Shanghai", the participants were not suffering diabetic retinopathy (DR) in Xinjing community in 2016 before interventions and received community-based interventions for diabetic eye diseases. The incidence of DR, visual acuity and awareness of DR were used as evaluation indicators to analyze the effects of interventions for diabetic eye diseases in the community. Results: A total of 537 patients were included in this study, the incidence of DR among diabetic patients in Xinjing community was 7.6% after interventions. The duration of diabetes (OR= 1.065) and HbA1c (OR= 1.090) were the risk factors of DR. Before and after the interventions, the patients with monocular low vision and binocular low vision were 27 cases (5.0%), 8 cases (1.5%), 19 cases (3.5%) and 7 cases (1.3%) respectively. After interventions, the awareness on the prevention and treatment of DR increased significantly, and the proportion of regular visits to ophthalmology examination, diet control and physical exercise also increased significantly. Conclusion: Community-based interventions for diabetic eye diseases are helpful to improve the awareness of DR prevention and control, reduce the incidence of DR.

Determination of prucalopride in human plasma by LC-MS/MS analysis / 中国药理学通报

Aim To develop an LC-MS/MS method for the determination of prucalopride(PCP)in human plasma.Methods Prucalopride -13CD3(dPCP)was used as the internal standard.The analytes were extracted from human plasma through liquid-liquid extraction method using ethyl acetate, followed by being dried, and then the reconstitution was injected into LC-MS/MS systems.Agilent ZORBAX SB C18(3.0×100 mm, 3.5 μm)column and isocratic elution system composing of methanol and 1 mmol·L-1 ammonium acetate(80:20, V/V)provided chromatographic separation of PCP and dPCP.AB Sciex API4000 mass spectrometer equipped with an electrospray ionization source in positive ion mode was employed for mass detection, and data acquisition was carried out in multiple reaction monitoring(MRM)mode.The mass transition ion-pair was followed as m/z 368.4/196.0 for PCP and m/z 374.4/198.0 for dPCP.Results PCP and dPCP were eluted at 3.6 min, with no interference in human blank plasma.PCP in human plasma showed good linearity over the concentration range of 0.058 96-7.547 μg·L-1 with the correlation coefficient of 0.996 3-0.999 6.The lower limit of quantitation of this method was 0.058 96 μg·L-1.The intra-batch and inter-batch accuracy ranged from 98.29% to 108.2%, with good precision(CV<5.2%).The average matrix factors of normal, haemolysed and lipaemic matrix human samples all ranged from 96.48% to 106.3% with CV less than 8.39%.The average extraction recoveries of PCP at low, medium and high concentrations were 89.88%, 95.27% and 94.52% respectively, with CV less than 7.21%.PCP was stable in human samples after 6 h at room temperature, 60 h at -20 ℃, 56 days or three freeze-thaw cycles at -80 ℃; meanwhile, the processed plasma samples remained stable after being stored for 24 hours in autosampler at 8 ℃.Furthermore, PCP in human blood samples was proved to be stable after 4 h at room temperature.Conclusions The present LC-MS/MS method for the determination of PCP in human plasma was convenient, accurate, sensitive, stable, specific and reproducible and was proved to be suitable for the clinical pharmacokinetics and bioequivalence studies of PCP preparations.

Clinical observation of the curative effect after 5-year follow-up of single tooth implant-supported restorations in the posterior region / 北京大学学报(医学版)

OBJECTIVE@#To analyze the clinical curative effect after 5-year follow-up of single tooth implant-supported restorations in the posterior region.@*METHODS@#In the study, patients with single tooth implant-supported restorations in the posterior region after loading 5-year in the Second Clinical Division of Peking University School and Hospital of Stomatology from October 2005 to May 2010 was enrolled. The implant survival rate, prosthetic conditions (including the structural integrity or loosening of the prosthesis, the retention of the materials used to fill access holes of screw-retained implant crowns, loosening or fractures of the implant abutment or screw) and marginal bone lever level around implants were determined by clinical and radiographic examination.@*RESULTS@#The study was composed of 215 patients, the mean age was 48.6 years (range: 27 to 71), and 321 soft tissue implants were inserted. There were 9 implants loose and lost during the visit, the cumulative success rate was 97.2%. In the 312 remaining implants, 120 implants were placed in the upper jaws (38.5%) and 192 in the lower jaws (61.5%). Three different diameters as 3.3 mm (5 implants), 4.1 mm (115 implants) and 4.8 mm (192 implants) and three different lengths as 8 mm (21 implants), 10 mm (206 implants) and 12 mm (85 implants) were used, respectively. 277 (88.8%) cement-retained and 35 (11.2%) screw-retained implant-supported single crowns were made. The marginal bone loss (MBL) around dental implants after loading 5 years in the mesial and distal sides were (0.73±0.25) mm and (0.78±0.26) mm, respectively. There was no significant difference among MBL and bone quality, implant type, angle of abutment, prosthodontic type, crown-to-implant ratio, gender, and age of the patients (P > 0.05). The major mechanical complications after restoration involved loosening (8.6%) and fracture (2.9%) of the crown retainer screw, loss of resin covering the screw (11.4%), and the most frequent mechanical complications were loss of crown retention (14.1%) and fracture of porcelain (13.8%). The incidence of loss of crown retention was correlated with insufficient clinical crown height or using angle abutment (P < 0.05).@*CONCLUSION@#After loading 5 years, the bone level around the soft-tissue-implant placed in posterior region was stable. To minimize the frequency of mechanical complications after restoration, protocols must be established from diagnosis to the completion of treatment and follow up of implant-supported prostheses, especially in terms of adequate technical steps and careful radiographic evaluation of the components.

Effects of leptin-modified human placenta-derived mesenchymal stem cells on angiogenic potential and peripheral inflammation of human umbilical vein endothelial cells (HUVECs) after X-ray radiation / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Combined radiation-wound injury (CRWI) is characterized by blood vessel damage and pro-inflammatory cytokine deficiency. Studies have identified that the direct application of leptin plays a significant role in angiogenesis and inflammation. We established a sustained and stable leptin expression system to study the mechanism. A lentivirus method was employed to explore the angiogenic potential and peripheral inflammation of irradiated human umbilical vein endothelial cells (HUVECs). Leptin was transfected into human placenta-derived mesenchymal stem cells (HPMSCs) with lentiviral vectors. HUVECs were irradiated by X-ray at a single dose of 20 Gy. Transwell migration assay was performed to assess the migration of irradiated HUVECs. Based on the Transwell systems, co-culture systems of HPMSCs and irradiated HUVECs were established. Cell proliferation was measured by cell counting kit-8 (CCK-8) assay. The secretion of pro-inflammatory cytokines (human granulocyte macrophage-colony stimulating factor (GM-CSF), interleukin (IL)-1α, IL-6, and IL-8) was detected by enzyme-linked immunosorbent assay (ELISA). The expression of pro-angiogenic factors (vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF)) mRNA was detected by real-time quantitative polymerase chain reaction (RT-qPCR) assay. Relevant molecules of the nuclear factor-κB (NF-κB) and Janus kinase (JAK)/signal transducer and activator of transcription (STAT) signaling pathways were detected by western blot assay. Results showed that leptin-modified HPMSCs (HPMSCs/ leptin) exhibited better cell proliferation, migration, and angiogenic potential (expressed more VEGF and bFGF). In both the single HPMSCs/leptin and the co-culture systems of HPMSCs/leptin and irradiated HUVECs, the increased secretion of pro-inflammatory cytokines (human GM-CSF, IL-1α, and IL-6) was associated with the interaction of the NF-κB and JAK/STAT signaling pathways. We conclude that HPMSCs/leptin could promote angiogenic potential and peripheral inflammation of HUVECs after X-ray radiation.

Evaluation of clinical efficacy of a kind of digital complete denture / 北京大学学报(医学版)

OBJECTIVE@#To compare the clinical efficacy of a kind of complete dentures fabricated using computer aided design/computer aided manufacturing (CAD/CAM) workflow with that of the complete denture fabricated using conventional workflow.@*METHODS@#Twenty edentulous patients were included in this prospective, single-blind, self-controlled clinical trial. Two pairs of complete dentures were fabricated for each participant: one using the functional suitable denture (FSD) system with CAD/CAM, and the other using conventional fabrication workflow. In the final delivery appointment, the conventional dentures worn by the participant for 3 months at first. Then the participant swapped to wear digital denture for another 3 months. The patients' satisfaction and oral health related quality of life (OHRQoL) were measured using the visual analogue scale (VAS) and oral health impact profile (OHIP-20E) at baseline, 2 weeks, 1 month, 2 months, and 3 months following denture delivery. In addition, the masticatory efficiency of each pair of dentures was measured after three months adaptation period for each type of dentures.@*RESULTS@#The VAS scores of the twenty patients in FSD denture group on general satisfaction, ease of cleaning, ability to speak, esthetics, stability and oral health status on these six domains were higher than that of conventional denture group 3 months after delivery. While the VAS cores in FSD denture group on comfort, ability to chew and ability to chew up were the same as those of conventional denture group. But there was no significant difference (P>0.05). The VAS score on each domain in FSD denture group was higher than that of conventional denture group 3 months after delivery, three domains of which reached statistical significance (P < 0.05), involving functional limitation, psychological discomfort and total. The masticatory performance of the FSD denture (1.20±0.54) was slightly higher than that for the conventional denture (1.16±0.53), but the difference did not reach statistical significance (P=0.691).@*CONCLUSIONS@#The clinical efficacy of the FSD complete denture is comparable to that of the conventional complete denture. As for patient satisfaction and oral health related quality of life, FSD dentures received comparable scores as conventional complete dentures did.

Adefovir Dipivoxil plus Chinese Medicine in HBeAg-Positive Chronic Hepatitis B Patients: A Randomized Controlled 48-Week Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effects of a 48-week course of adefovir dipivoxil (ADV) plus Chinese medicine (CM) therapy, namely Tiaogan Jianpi Hexue () and Tiaogan Jiedu Huashi () fomulae, in hepatitis B e antigen (HBeAg)-positive Chinese patients.@*METHODS@#A total of 605 HBeAg-positive Chinese CHB patients were screened and 590 eligible participants were randomly assigned to 2 groups in 1:1 ratio including experimental group (EG, received ADV plus CM) and control group (CG, received ADV plus CM-placebo) for 48 weeks. The major study outcomes were the rates of HBeAg and HBV-DNA loss on week 12, 24, 36, 48, respectively. Secondary endpoints including liver functions (enzymes and bilirubin readings) were evaluated every 4 weeks at the beginning of week 24, 36, and 48. Routine blood, urine, and stool analyses in addition to electrocardiogram and abdominal B scan were monitored as safety evaluations. Adverse events (AEs) were documented.@*RESULTS@#The combination therapy demonstrated superior HBeAg loss at 48 weeks, without additional AEs. The full analysis population was 560 and 280 in each group. In the EG, population achieved HBeAg loss on week 12, 24, 36, and 48 were 25 (8.90%), 34 (12.14%), 52 (18.57%), and 83 (29.64%), respectively; the equivalent numbers in the CG were 20 (7.14%), 41 (14.64%), 54 (19.29%), and 50 (17.86%), respectively. There was a statistically significant difference between these group values on week 48 (P<0.01). No additional AEs were found in EG. Subgroup analysis suggested different outcomes among treatment patterns.@*CONCLUSION@#Combination of CM and ADV therapy demonstrated superior HBeAg clearance compared with ADV monotherapy. The finding indicates that this combination therapy may provide an improved therapeutic effect and safety profile (ChiCTR-TRC-11001263).

Whole Genome Analyses of Chinese Population and De Novo Assembly of A Northern Han Genome / 基因组蛋白质组与生物信息学报·英文版

To unravel the genetic mechanisms of disease and physiological traits, it requires comprehensive sequencing analysis of large sample size in Chinese populations. Here, we report the primary results of the Chinese Academy of Sciences Precision Medicine Initiative (CASPMI) project launched by the Chinese Academy of Sciences, including the de novo assembly of a northern Han reference genome (NH1.0) and whole genome analyses of 597 healthy people coming from most areas in China. Given the two existing reference genomes for Han Chinese (YH and HX1) were both from the south, we constructed NH1.0, a new reference genome from a northern individual, by combining the sequencing strategies of PacBio, 10× Genomics, and Bionano mapping. Using this integrated approach, we obtained an N50 scaffold size of 46.63 Mb for the NH1.0 genome and performed a comparative genome analysis of NH1.0 with YH and HX1. In order to generate a genomic variation map of Chinese populations, we performed the whole-genome sequencing of 597 participants and identified 24.85 million (M) single nucleotide variants (SNVs), 3.85 M small indels, and 106,382 structural variations. In the association analysis with collected phenotypes, we found that the T allele of rs1549293 in KAT8 significantly correlated with the waist circumference in northern Han males. Moreover, significant genetic diversity in MTHFR, TCN2, FADS1, and FADS2, which associate with circulating folate, vitamin B12, or lipid metabolism, was observed between northerners and southerners. Especially, for the homocysteine-increasing allele of rs1801133 (MTHFR 677T), we hypothesize that there exists a "comfort" zone for a high frequency of 677T between latitudes of 35-45 degree North. Taken together, our results provide a high-quality northern Han reference genome and novel population-specific data sets of genetic variants for use in the personalized and precision medicine.

Clinical observation on soft and hard tissue changes of immediate implantation and immediate reconstruction in anterior region after loading 3 years / 北京大学学报(医学版)

OBJECTIVE@#To observe the change of soft and hard tissue in dental immediate implantation and immediate reconstruction in anterior region after loading 3 years.@*METHODS@#Patients with single anterior tooth loss in the Department of Second Dental Center, Peking University School and Hospital of Stomatology from October 2008 to October 2012 were enrolled. The gingival papilla height, labial gingival margin level and peri-implant bone level were measured immediately after the permanent restoration and 3 years later.@*RESULTS@#In the study, 20 patients were treated by immediate implantation and immediate reconstruction for 22 implants; 24 patients were treated by delayed implant for 29 implants. Implant stability quotient (ISQ) value of the two groups showed no significant difference before permanent restoration (P>0.05). In all the cases after loading 3 years, the average mesial gingival papilla height in implant area of the immediate group and delayed group changed by (0.34±0.54) mm and (0.05±0.39) mm respectively (P=0.07), the distal gingival papilla height changed by (0.43±0.42) mm and (0.36±0.48) mm respectively (P=0.13), while the labial gingival margin level shrinkages were (0.70±0.40) mm and (0.62±0.34) mm respectively (P=0.23). Peri-implant bone losses in the mesial side were (1.02±0.50) mm and (0.88±0.46) mm respectively (P=0.53), while those in the distal side were (1.05±0.34) mm and (0.95±0.47) mm respectively (P=0.21). All these indicators showed no significant difference between the two groups (P>0.05); When the permanent prostheses delivered, the distributions of the gingival papilla index were different between the two groups whether in the mesial side or in the distal side (P<0.05).@*CONCLUSION@#The changes of the soft and hard tissue of the immediate implantation and immediate reconstruction in anterior region after loading 3 years were basically equivalent to the conventional implant restoration. But, the former was obviously better than the latter in reducing the duration of treatment and in getting the ideal dental papilla aesthetic effect.

Comparison study of two diagnostic and grading systems for conjunctivochalasis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Different diagnostic and grading systems of conjunctivochalasis have resulted in apparent disparity between the prevalence rates of recent population-based studies. This study aimed to investigate the disparity between 4-level system cited from Meller and Tseng in 1998 (abbreviated here as Meller's system) and 5-level system modified from Meller's system cited from Zhang and associates (abbreviated here as Zhang's system) regarding the diagnosis and the patients' preferences for the treatment of conjunctivochalasis in the general population.</p><p><b>METHODS</b>A total of 546 senile residents living in the Guiyangyuan community of Shanghai, China, participated in the study. The diagnostic criteria for conjunctivochalasis were based on two diagnostic grading systems: Meller's system and Zhang's system, which was modified from Meller's system. The participants' preference regarding medical treatment for conjunctivochalasis was determined according to the response to a question. One year later, a follow-up interview determines whether the patient had undergone surgery for conjunctivochalasis.</p><p><b>RESULTS</b>With Meller's system, 398 participants were confirmed as having conjunctivochalasis, and the prevalence rate was 72.89%. According to Zhang's system, only 213 participants were diagnosed as having conjunctivochalasis, and the prevalence rate was 39.01%. A total of 109 eyes underwent medical treatment or surgery for conjunctivochalasis in the following year, including eight eyes that were diagnosed as grade II and 101 eyes that were diagnosed as grade III according to Meller's system and five eyes that were diagnosed as grade I, 55 eyes that were diagnosed as grade II, 31 eyes that were diagnosed as grade III, and 18 eyes that were diagnosed as grade IV according to Zhang' system.</p><p><b>CONCLUSION</b>Diagnoses of conjunctivochalasis using Zhang's system are more consistent with patient requests and the medical treatment strategies used than diagnoses made using Meller's system.</p>

Evaluation of the therapeutic efficiency of mandibular anterior implant-supported fixed bridges with cantilevers / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Dental implant technology has developed rapidly in recent years. However, the use of implant-supported fixed bridges with cantilevers has been controversial. The purpose of this study was to evaluate the clinical results of the mandibular anterior implant-supported fixed bridges with a cantilever. Method Thirty-three patients (15 males, 18 females; mean age, 42.6 years; range 20-54 years) with two missing anterior mandibular teeth had single implant-supported fixed bridges with a cantilever. Clinical examination was recorded and radiographs were taken. The mean duration of follow-up was 30 months (15-44 months).</p><p><b>RESULTS</b>All implants survived. Loosening or fracture of the prosthesis was not observed. All patients were satisfied with the treatment. The mean bone resorption values after 12, 24, and 36 months of implant loading were 0.94, 1.18 and 1.35 mm respectively. The changes of gingival papilla height ranged from 0 to 0.5 mm. There was significant difference between 1-year and 2 or 3 years restoration groups regarding the average gingival height changes (P < 0.05).</p><p><b>CONCLUSION</b>After careful and precise selection of patients, restoration with a single implant-supported fixed bridge with a cantilever can be recommended if two anterior mandibular teeth are missing.</p>

Technical specifications for intensive hospital safety monitoring of post-marketing Chinese medicine (draft version for comments) / 中国中药杂志

It is of vital significance to conduct active post-marketing surveillance of Chinese medicine, as an active response to laws, rules and guidelines issued by the China food and drug administration. The standards for technological specifications based on expert consensus have been drafted. These will provide technological support in evaluating adverse drug reactions (ADRs) or adverse drug events (ADEs). The technological specifications for post-marketing surveillance focus on two surveillance designs; one is a large sample registry study to explore general population ADR/ADE characteristics, the other is a nested case-control study to explore the characteristic and mechanisms of ADRs.

Comparative effects of Roux-en-Y gastric bypass procedures preserving different gastric volume on blood glucose in Goto-Kakizaki rats / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the effects of Roux-en-Y gastric bypass (RYGBP)procedures preserving different gastric volume on blood glucose of rats with non-obese type 2 diabetes.</p><p><b>METHODS</b>A total of 36 Goto-Kakizaki rats randomly underwent one of the following procedures: gastric bypass with different types of anastomosis including the Roux-en-Y of total stomach excision(n=12), the Roux-en-Y of partial stomach excision(n=12) and the Roux-en-Y of stomach preservation(n=12). Rats were observed for 24 weeks after surgery. Body weight, food intake and fasting blood glucose level were tested at 0(preoperative), 1, 3, 6, 12, 24 weeks. Hemoglobin A1c(HbA1c) level was measured at 0, 12, 24 weeks and glucose tolerance test (OGTT) was performed in conscious rats before (baseline) and then 30, 60, 120, and 180 minutes. Change of blood glucose over time was depicted. Area under curve(AUC) of glucose tolerance were calculated.</p><p><b>RESULTS</b>Compared with preoperative levels, the weight and food intake of all the rats were significantly decreased at 1 week after surgery(P<0.01). At 3 weeks after operation, the weight and food intake were significantly increased compared with 1 week after operation in the Roux-en-Y of partial stomach excision and the Roux-en-Y of stomach retention(P<0.01). In the Roux-en-Y of total stomach excision, the weight and food intake were significantly lower compared with other two groups(P<0.05). At 24 weeks after operation, the levels of fasting blood glucose were (7.3 ± 1.5), (7.5 ± 2.0) and (8.3 ± 1.3) mmol/L, which were lower than the preoperative levels [(13.2 ± 1.6), (13.6 ± 2.5) and (12.9 ± 2.0) mmol/L, P<0.01] in the three groups. There were no significant differences among the three groups(P>0.05). At 24 weeks after operation, the HbA1c levels were(6.3 ± 1.3)%, (6.4 ± 2.0)% and (7.0 ± 1.3)%, which were lower than the preoperative level[(10.2 ± 2.6)%, (9.6 ± 2.5) and (9.9 ± 2.0)%, P<0.01]. There were no significant differences among the three groups(P>0.05). The trend of the glucose tolerance test and AUC were similar in the three groups after operation.</p><p><b>CONCLUSION</b>Roux-en-Y gastric bypass in non-obese diabetic rats is effective in terms of glucose control and the efficacy of gastric bypass has no obvious association with the stomach volume.</p>

Cross-sectional investigation of visual impairing diseases in Shanghai blind children school / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The control of blindness in children is a high priority within the VISION 2020 initiative. To determine the causes of severe visual impairment and blindness in children from Shanghai Blind Children School (SBCS) can provide useful information on childhood blindness in Shanghai.</p><p><b>METHODS</b>A cross-sectional investigation of students in SBCS was conducted in May 2010. The World Health Organization/Prevention of Blindness (WHO/PBL) eye examination record system for children with low vision and blindness was used. The results were further compared with the findings of two previous investigation studies conducted in 1986 and 2004, respectively in SBCS.</p><p><b>RESULTS</b>Of the 146 children observed, 80 children (54.8%) were blind (best corrected best visual acuity less than 0.05), 27 children (18.5%) had severe visual impairment (best corrected visual acuity less than 0.1 but better than or equal to 0.05), and 34 children (23.3%) had moderate visual impairment (best corrected visual acuity less than 0.3 but better than or equal to 0.1). The major affected anatomic sites in the 107 children with severe visual impairment and blindness (SVI/BL) were retina (47.7%), whole globe (16.8%), optic nerve (13.1%) and lens (9.3%). The leading causes of SVI/BL were retinopathy of prematurity (ROP, 25.2%), followed by retinal dystrophy (15.9%), optic nerve atrophy (9.3%) and microphthalmos (9.3%). The two leading etiologic categories of SVI/BL were perinatal/neonatal (36.4%) and congenital/hereditary groups (29.0%). The leading cause of moderate visual impairment was aphakia after cataract surgery (congenital cataract, 44.1%). Compared with the findings in two previous investigations in SBCS, the proportion of ROP in visual impairing diseases increased, while the proportion of disorders of the lens (cataract and aphakia) significantly decreased.</p><p><b>CONCLUSIONS</b>The leading cause of childhood blindness in SBCS nowadays is ROP. It is projected that without improvement in perinatal medical care that ROP will continue to be a major cause of childhood blindness.</p>

Comparison of the Effects of Propofol and Midazolam on Inflammation and Oxidase Stress in Children with Congenital Heart Disease Undergoing Cardiac Surgery

PURPOSE: To investigate and compare the effects of propofol and midazolam on inflammation and oxidase stress in children with congenital heart disease undergoing cardiac surgery. MATERIALS AND METHODS: Thirty-two ASA class I-II children with congenital heart disease undergoing cardiac surgery were randomly divided into two groups: propofol combined with low dose fentanyl (PF group, n = 16) and midazolam combined with low dose fentanyl (MF group, n = 16). Tracheal extubation time and length of Intensive Care Unit (ICU) stay were recorded. Blood samples were taken before operation (T0), at 2 h after release of the aorta cross-clamp (T3) and at 24 h after operation (T4) to measure interleukin 6 (IL-6), IL-8, superoxide dismutase (SOD) and malondialdehyde (MDA) levels. Myocardium samples were collected at 10-20 min after aorta cross-clamp (T1) and at 10-20 min after the release of the aorta cross-clamp (T2) to detect heme oxygenase-1 (HO-1) expression. RESULTS: Tracheal extubation time and length of ICU stay in PF group were significantly shorter than those of the MF group (p < 0.05, respectively). After cardiopulmonary bypass, IL-6, IL-8 and MDA levels were significantly increased, and the SOD level was significantly reduced in both two groups, but PF group exhibited lower IL-6, IL-8 and MDA levels and higher SOD levels than the MF group (p < 0.05, respectively). The HO-1 expression in the PF group was significantly higher than that in MF group at the corresponding time points (p < 0.05, respectively). CONCLUSION: Propofol is superior to midazolam in reducing inflammation and oxidase stress and in improving post-operation recovery in children with congenital heart disease undergoing cardiac surgery.

Posterior vitreous cortex contributes to macular hole in highly myopic eyes with retinal detachment / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It was well known that tangential vitreoretinal traction and epiretinal membrane play important roles during the formation of macular hole (MH) associated with retinal detachment (RD) in highly myopic eyes. But it was not clear about the correlations between anteroposterior traction, posterior vitreous cortex (PVC) and MH-RD. The vitreous status in highly myopic eyes were analyzed to explore the effect of PVC in the role of MH-RD formation.</p><p><b>METHODS</b>Sixteen consecutive highly myopic eyes with RD due to MH were retrospectively analyzed from January 2009 to April 2009. The preoperative examinations for detecting posterior vitreous detachment (PVD) and vitreoretinal traction included B-mode ultrasonography and optical coherence tomography (OCT). The residual PVC and PVD were confirmed intraoperatively during triamcinolone acetonide (TA) assisted vitrectomy.</p><p><b>RESULTS</b>Under ultrasonography, the preoperative PVD patterns were stratified as: complete PVD in three (19%) eyes, partial PVD in eight (50%) eyes, and no PVD in five (31%) eyes. OCT confirmed vitreoretinal traction and no complete PVD in 10 (63%) eyes, including anteroposterior traction in four eyes and tangential traction in six eyes. During TA-assisted vitrectomy, it was confirmed that no complete PVD existed in 16 eyes, including six eyes (38%) finally diagnosed of partial PVD, and five (31%) eyes with vitreoschisis. Anteroposterior vitreoretinal traction around MH is always in conjunction with partial PVD (67%), and high proportion (80%) of vitreoschisis is associated with tangential vitreoretinal traction. Comparing with the precision of TA staining of PVD diagnosis, the coincidence rate of ultrasonography was 69% (P = 0.02), and that of OCT was 63% (P < 0.01).</p><p><b>CONCLUSIONS</b>The residual PVC due to partial PVD or vitreoschisis may cause the anteroposterior or tangential traction of macular area, which contributes to the formation of MH and subsequent RD in highly myopic eyes. And it is necessary to realize the vitreoretinal relationship and assess the status of PVC synthetically for surgery by combined ultrasonography and OCT preoperatively and TA staining intraoperatively.</p>

Vocal fold augmentation by injection of autologous fascia and fat / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of combination of autologous fascia and fat injection into vocal fold for the treatment of patients with unilateral vocal fold paralysis and to observe the long-term effectiveness of this procedure.</p><p><b>METHODS</b>A total of 26 unilateral vocal fold paralysis patients underwent vocal fold injection under general anesthesia, meanwhile, the mucosa of the injected point was sutured through laryngoscope under direct vision. There were 6 patients underwent autologous fat injection into vocal fold (group A), and 20 patients underwent autologous anterior rectus sheath fascia and fat injection (group B). Therapeutic efficacy were evaluated by videostroboscopy, voice-related parameters analysis and voice evaluation before and after treatment. Clinical analysis of this procedure was retrospectively performed in this serial of patients.</p><p><b>RESULTS</b>All patients were followed up for 24 months. On the third day after operation, there was an acute inflammatory reaction induced by the graft. This reaction disappeared three months later. In all 20 cases, videolaryngostroboscopy showed significant improvement of the glottic closure, the improvement in acoustical parameters was statistically significant (P < 0.01). Perceptual evaluation of GRBAS scale showed significant improvement of phonatory function on G, B, A scale. The results remained stable 6 - 24 months after operation and were not changed by the length of follow-up. And in the 6 cases, videolaryngostroboscopy showed significant improvement of the glottic closure at 3 months compared with preoperative observation, a little spindle-shaped disclosure. The improvement in acoustical parameters was significant statistically at 3, 6 and 24 months (P < 0.05 or < 0.01), the voice quality decreased significantly at 6 and 24 months compared with 3 months (P < 0.05 or < 0.01). The significant differences were not observed between 6 and 24 months (P > 0.05). No complications were observed in all patients perioperatively or during the follow-up period. Voice-related parameters jitter, normalized noise energy and maximum phonation time showed significant differences between Group A and Group B on 24 months (P < 0.05 or < 0.01).</p><p><b>CONCLUSION</b>The combination of autologous fascia and fat vocal fold injection is an effective procedure for the treatment of unilateral vocal fold paralysis, and the stable results can be achieved during the follow-up period for 24 months.</p>

Association between lymphangiogenesis and clinicopathological features and prognosis in laryngeal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To detect lymphangiogenesis by labeling the lymphatic endothelial marker, lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), and study the prognostic relevance of lymphangiogenesis in laryngeal squamous carcinoma.</p><p><b>METHODS</b>Clinical files and specimens of 78 patients with histologically diagnosed laryngeal carcinoma were stained with LYVE-1 as a specific lymphatic endothelial marker. The lymphatic vessel density (LVD) was measured, and the correlation between LVD and clinicopathological features of the tumor cases was analyzed.</p><p><b>RESULTS</b>The mean LVD in laryngeal carcinoma (13.24 ± 5.09) was significantly higher than that in adult laryngeal papilloma (5.54 ± 3.15) and squamous dysplasia (6.76 ± 4.45, P < 0.05). The LVD of poorly differentiated tumors (15.74 ± 5.24) was significantly higher than that in the moderately differentiated tumors (13.84 ± 6.20), and the LVD in the moderately differentiated tumors was significantly higher than that in the well-differentiated tumors (11.68 ± 6.34). The LVD in stage 0 to stage II group (10.66 ± 5.70) was significantly lower than that in the stage III to IV group (17.01 ± 6.35). The lymph node metastasis group (17.25 ± 7.37) was significantly higher than non-lymph node metastasis group (8.60 ± 5.23, P < 0.05). There was no significant association between LVD and age, sex, primary site and distant metastasis. The overall survival in the patients with a LVD higher than the mean value was 33.5 month, and that of cases with a LVD lower than the mean value was 81.6 month (P < 0.05). The multivariate survival analysis showed that the clinical stage and LVD were independent prognostic factors of laryngeal cancer.</p><p><b>CONCLUSIONS</b>The LYVE-1 staining histochemistry demonstrates that the lymphangiogenesis occurrs mainly at the edge of the tumors, and lymphangiogenesis plays an important role in the carcinogenesis, cancer progression and lymph node metastasis in laryngeal cancer. LVD may be an independent indicator of poor prognosis of laryngeal cancer.</p>

Early treatment with high-volume hemofiltration combined with rhubarb for patients with severe acute pancreatitis / 第二军医大学学报

Objective: To investigate the effect of early treatment with a combination of rhubarb and high volume hemofiltration for patients with severe acute pancreatitis(SAP). Methods: We retrospectively analyzed the 31 SAP patients, who were treated in our department between June 2005 and December 2007. Twelve patients (control group) received high-volume hemofiltration only and the other 19 patients(treatment group)received both hemofiltration and rhubarb-enchyma infused via a gastric tube for three days. The vital signs and recovery of gastrointestinal functions were observed in the two groups. The serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and plasma endotoxin were measured in the two groups. Results: The vital signs of all the patients were stable during the treatment. The APACHE II score and serum cytokine concentrations were significantly decreased in the two groups after treatment(P0.05). Gastrointestinal function of the treatment group recovered earlier, with an effective rate significantly higher than that of the control group(P<0.05). The plasma endotoxin of the control group were gradually elevated during the treatment; that of the treatment group increased first and then gradually decreased; and there was significant difference between the two groups (P<0.05). Conclusion: High-volume hemofiltration can clear the plasma inflammatory mediators and cytokines. Rhubarb can improve the gastrointestinal function and decrease the plasma endotoxin level of SAP patients; early treatment with a combination of both can improve the clinical outcomes of patients.

Protective effect of Shen fu injection against intestinal barrier dysfunction and second hit in rats with severe acute pancreatitis / 第二军医大学学报

Objective: To evaluate the protective effect of Shenfu injection (SFI) against intestinal barrier dysfunction and second hit in rats with severe acute pancreatitis (SAP). Methods: Fifty-four male Wistar rats were randomly divided into sham operation group (n = 6), SAP group (n = 24), and SAP + SFI group (10 ml/kg body wt, n = 24). Sham operation group underwent laparotomy only. SAP model was established by retrograde injection of 5% sodium taurocholate into the bilipancreatic duct of Wistar rats. SAP+SFI group was given SFI (10 ml/kg) intaperitoneally 2 h before SAP establishment. Rats were sacrificed at 3,6,12 and 24 hours after operation. The samples of pancreas, lung and liver were collected for measuring the levels of myeloperoxidase (MPO) at 3,6,12, and 24 h after injection of sodium taurocholate. The pathological changes of the terminal ilea were observed under light microscopy, and the blood levels of diamine oxidase (DAO), tumor necrosis factor alpha (TNF-α) and interleukin-6(IL-6) were also measured at different time points. Results: The blood levels of TNF-α, IL-6 and DAO in SAP group were significantly higher than those in the sham operation group at all time points (P<0.01). The levels of intrapulmonary, intrapancreatic and intrahepatic MPO in SAP group were significantly than those in the sham operation group at 6,12, and 24 hours (P<0.01). The contents of DAO, TNF-α and IL-6 were significantly decreased in SAP + SFI group compared with in SAP group at all time points (P<0.05 or P<0.01). The contents of intrapulmonary, intrapancreatic and intrahepatic MPO were significantly decreased in SAP+SFI group compared with SAP group at 6,12, and 24 h after operation (P<0.05 or P<0.01). Intestinal pathological damages were obviously milder in SAP+SFI group than that in SAP group at 24 h after operation. Conclusion: SFI can protect the small intestine mucosal barrier and other organs from second hit by reducing the polymorphonuclear leucocyte detaining and inhibiting TNF-α and IL-6.