Effect of High Suspension and Low Incision Surgery Based on Traditional Ligation of Chinese Medicine in Treatment of Mixed Haemorrhoids: A Multi-centre, Randomized, Single-Blind, Non-inferiority Clinical Trial / 中国结合医学杂志

OBJECTIVE@#To observe the clinical effect of high suspension and low incision (HSLI) surgery on mixed haemorrhoids, compared with Milligan-Morgan haemorrhoidectomy.@*METHODS@#A multi-centre, randomized, single-blind, non-inferiority clinical trial was performed. Participants with mixed haemorrhoids from Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing Rectum Hospital, Air Force Medical Center of People's Liberation Army of China, and Puyang Hospital of Traditional Chinese Medicine were enrolled from September 2016 to March 2018. By using a blocked randomization scheme, participants were assigned to two groups. The experimental group was treated with HSLI, while the control group was treated with Milligan-Morgan haemorrhoidectomy. The primary outcome was the clinical effect evaluated at 12 weeks after operation. The secondary outcomes included the number of haemorrhoids treated during the operation, pain scores, use of analgesics, postoperative oedema, wound healing, incidence of anal stenosis, anorectal manometry after operation, as well as surgical duration, length of stay and total hospitalization expenses. A safety evaluation was also conducted.@*RESULTS@#In total, 246 eligible participants were enrolled, with 123 cases in each group. There was no significant difference in the clinical effect between the two groups (100.00% vs. 99.19%, P>0.05). Compared with the control group, the number of external haemorrhoids treated during the operation and the pain scores after operation were significantly reduced in the experimental group (P0.05). The surgical duration and length of stay in the experimental group were significantly longer than those in the control group, and the total hospitalization expense was significantly higher than that in the control group (all P<0.05). No adverse events were reported in either group during the whole trial or follow-up period.@*CONCLUSION@#HSLI had the advantages of preserving the skin of anal canal completely, alleviating postsurgical pain and promoting rapid recovery after operation. (Registration No. ChiCTR1900022883).

Mechanism of intermittent and persistent noise exposure-induced anxiety and depression-like behavior in rats / 中国职业医学

OBJECTIVE: To investigate the effects and mechanisms of intermittent and persistent noise exposure-induced anxiety and depression-like behavior in rats. METHODS: The specific pathogen free male SD rats were randomly divided into control group, four times/day intermittent noise exposure group, two times/day intermittent noise exposure group and persistent noise exposure group, with 15 rats in each group. The rats in the control group were housed in natural environment(background noise ≤50 dB), and the rats in other three exposure groups were exposed to noise with intensity of(95±2) dB of 20 to 20 000 Hz noise for four hours per day for 14 days; rats in the four times/day intermittent noise exposure group entered a five-hour quiet period every one hours of noise exposure, four times/day; rats in the two times/day intermittent noise exposure group entered a 10-hour quiet period every two hours of noise exposure, two times/day; rats in the persistent noise exposure group entered a 20-hour quiet period every four hours of noise exposure. After exposure, anxiety like behavior was evaluated by open field test and elevated cross maze test. The depression like behavior was evaluated by sugar preference test and forced swimming test. The pathological changes of neurons in the hippocampus were observed by hematoxylin-eosin(HE) staining, and the ultrastructural changes of hippocampal tissues were observed by transmission electron microscope. Chemiluminescence and colorimetry were used to detect the levels of reactive oxygen species(ROS), malondialdehyde, glutathione(GSH) and the activity of superoxide dismutase(SOD). RESULTS: In the behavioral experiment, the percentage of exercise time in the central area decreased in the three noise exposure groups(all P<0.01). The exercise distance in the central area and sugar preference index decreased in the persistent noise exposure group(both P<0.01). The percentage of open arm exercise time and open arm exercise distance decreased in the two times/day intermittent noise exposure group and persistent noise exposure group compared with the control group(all P<0.01). The open arm distance of rats in the persistent noise exposure group were lower than those in the four times/day intermittent noise exposure group(P<0.05), while the immobility time was longer than in control group and the four times/day intermittent noise exposure group(both P<0.05). The HE staining showed that the neuronal spacing in CA1 area of the hippocampus of rats was significantly widened, and the pyramidal cells showed degeneration and necrosis in the persistent noise exposure group. There was no obvious necrosis found in the neurons of the other three groups. The ultrastructure of neurons showed that most mitochondria of cells in the hippocampus of rats in the two times/day intermittent noise exposure group were swollen. In the persistent noise exposure group, some neurons of the hippocampus of rats were necrotic, the cell membrane was discontinuous, the mitochondria were swollen, and the cristae were broken, dissolved or even disappeared. The mitochondrial structure of the hippocampus of rats in the other two groups was normal. The activity of SOD in the hippocampus of rats decreased in the four times/day intermittent noise exposure group(P<0.05), and the activity of SOD and the level of GSH in the hippocampus of rats decreased in the two times/day intermittent noise exposure group(both P<0.05), compared with the control group. The level of ROS and malondialdehyde in the hippocampus of rats in the persistent noise exposure group increased(all P<0.05), while the SOD activity and GSH level decreased(all P<0.05), compared with the other three groups. CONCLUSION: Intermittent noise exposure causes less anxiety and depression-like changes in rats than persistent noise exposure. Noise may cause anxiety and depression in rats through oxidative stress pathways.

Prevention of hematoma on the floor of the mouth during dental implant surgery in the anterior mandible / 口腔疾病防治

Objective@# To explore the cause and preventive measures of floor-of-mouth hematoma after dental implant placement. @*Methods@#The prevention of hematoma of the floor of the mouth in a case of lower anterior teeth implant placement was analyzed, and the literature was reviewed.@*Results@# Four mandibular vascular canals were found on the lingual side of the anterior mandible before dental surgery in the reported case. Two of them were quite thick (1.4 mm and 1.0 mm, respectively) and were located adjacent to the crest of the alveolar bone and superior to the mental spine. These two thick endosseous branches from the sublingual artery were dissected and ligated , and there was no obvious hematoma in the patients immediately after the operation and at the postoperative 3 d review. The results of the literature review show that the incidence of endosseous branches from the lingual vascular canal of the mandible is 90%-100%. The distribution of the vessels on the lingual side of the mandible is highly variable and adjacent to the lingual cortical plate. Accidental injury of the lingual cortical plate during implant surgery would probably lead to bleeding or hematoma on the floor of the mouth. @*Conclusion @#Mastering the anatomy of blood vessels on the floor of the mouth, elaboratively examining preoperative three-dimensional radiographic imaging, and cautiously exploring the lower jaw bone morphology after flap elevation are preventive measures to avoid damage to the arterial supply on the lingual side of the anterior lower jaw and to prevent complications of hematoma in the floor of the mouth.

Correlating transmural extent of acute myocardial infarction to left ventricular stain by mrifeature tracking / 中国介入心脏病学杂志

Objective The left ventricular myocardial strain of acute myocardial infarction on cardiac magnetic resonance cine imaging was measured by feature tracking technique. The relationship between left ventricular myocardial strain and the transmural extent of Myocardial Infarction was evaluated. Methods 74 patients with acute ST segment elevation myocardial infarction were included. All theses patients received primary PCI within 12 hours. After 2 to 5 days. ECG gated steady-state free precession sequences were collected. Gadolinium contrast enhanced imaging was performed on short axis. 20 patients repeated same scan after 3 to 5 months. TomTec 2D CPA and Segment software were used to analyze the images. The peak values of the regional myocardial strain indexes. The transmural extent of myocardial infarction of segment in left ventricular was measured. Results There was no significant difference of longitudinal strain in non-infarction,non-transmural infarction and transmural infarction segments at the basal and middle segments. The circumferential strain peak and the radial strain peak of non-transmural infarction segments were lower than those of the non-infarction segments. The circumferential strain of transmural infarction segments were the lowest(basal level:-14.24％±9.05％,P<0.05;middle level:-12.71％±8.92％,P<0.05;apical level:-13.81％±11.13％, P<0.05). GLS was improved while LVDd was increased when compared the acute phase of myocardial infarction to that of 3-5 months after primary PCI. The circumferential strain and longitudinal strain of the non-transmural infarction segments was improved. The circumferential strain and radial strain of the transmural infarction segments 3-5 months later was improved as compared to the acute phase. Conclusions There was differences in myocardial strain in non-infarction,non-transmural infarction and transmural infarction segments from patients with acute ST segment elevation myocardial infarction who had accepted primary PCI. The circumferential strain and longitudinal strain of the non-transmural infarction segments were improved after 3-5 months. The circumferential strain and radial strain of the transmural infarction segments after 3-5 months was improved as compared to the acute phase. Cardiac Magnetic resonance could combine feature tracking technique with gadolinium contrast delayed enhancement technique,giving both function and tissue characteristic evaluation to the myocardial damages after acute myocardial infarction.

Biological Effects of Chlamydiaphage phiCPG1 Capsid Protein Vp1 on Chlamydia Trachomatis In Vitro and In Vivo / 华中科技大学学报（医学）（英德文版）

The researches on chlamydia in recent years show that chlamydia bacteriophage may be a potential and effective means to solve the clinical infection of chlamydia trachomatis (Ct).We investigated the biological effect of chlamydiaphage phiCPG1 capsid protein Vp1 on Ct both in McCoy cells and genital tract of mice.Different concentrations of Vp1 were co-incubated with Ct E serotype strain in McCoy cells.Female BALB/c mice were used to establish Ct E strain-induced urogenital infection model.They were randomly divided into five groups and given different treatments on the fifth day after Ct inoculation.Animals in groups 1 and 2 were given 30 μL different concentrations of Vp1 in the genital tract respectively,those in group 3 were intramuscularly injected with 30 μL Vp1,those in the infected group did not receive any intervention,and those in the control group received 30 μL PBS in the genital tract.The vaginal discharge was collected to identify the live chlamydia by cell culture and gene fragment by real time PCR different days after infection.Inhibition rate of 100 μg/mL and 50 μg/mL Vpl proteins against Ct E strain in the McCoy cell cultures was 91％ and 79％ respectively,The number of intracellular Ct inclusion in the McCoy cells co-cultured with vaginal discharge of group 1 and group 2 was less than in the infected group,and that in group 1 was less than in group 2,on the 7th day after Ct inoculation.Real-time PCR showed that chlamydia concentration of the vaginal discharge in group 2 was lower than in the infected group,and that in group 1 was lower than in group 2 on the 10th day.It was suggested that Vp1 capsid proteins had inhibitory effect on the proliferation of Ct serovar E strain in cell culture and mouse genital tract.

DPP-4 Inhibitor for the Treatment of Type 2 Diabetes and Intellectual Property Analysis / 中国药师

DPP-4 inhibitors are new oral hypoglycemic drugs and hot spots developed and launched in recent years, and they pro-vide new choices for the clinical treatment of type 2 diabetes. In China, DPP-4 inhibitors that are approved to use in the treatment of type 2 diabetes are all imported products currently. In the paper, the current intellectual property situation of DPP-4 inhibitors that are developed and approved at home and abroad is researched and analyzed. Reasonable use of the patent information of DPP-4 inhibitors that is about to expire or have failed can provide good guidance for the subsequent development of DPP-4 inhibitors in domestic with promising curative effect and good market prospects, and can generate new patents in order to enhance the market competitiveness.

Clinical value of double respiratory navigator-gated high-resolution black-blood coronary artery wall magnetic resonance imaging / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the value of phase ordering with automatic window selection(PAWS)and simultaneous multiple volume(SMV)algorithm double respiratory navigator-gated two-dimensional(2DNAV)dual inversion recovery(DIR)fast spin echo(FSE)high-resolution black-blood coronary artery wall magnetic resonance imaging(MRI)and evaluate its advantages and limitations.</p><p><b>METHODS</b>PAWS and SMV 2DNAV DIR FSE high-resolution black-blood MRI was performed in 21 healthy volunteers. The images were evaluated qualitatively by using four grades(grade 0can not evaluate;grade 1bad;grade 2good;grade 3perfect). Images defined as grade 0 and grade 1 were excluded and those defined as grade 2 and 3 were evaluated further. Thickness of proximal(or middle)segment of right coronary artery(RCA)and left anterior descending branch(LAD)were measured. The difference of wall thickness was analyzed by using two-tailed independent sample t-test. P values of less than 0.05 were considered statistically significant.</p><p><b>RESULTS</b>Among the 38 slice images,31 slices(RCA13 slices,LAD18 slices;grade 214 slices,grade 317 slices)were obtained for further evaluation. The mean thickness of RCA and LAD was(0.94±0.16)and(0.89±0.15)mm,respectively,and the difference was not significant(t=-0.790,P>0.05).</p><p><b>CONCLUSION</b>PAWS and SMV algorithm 2DNAV DIR FSE high-resolution black-blood MRI has certain clinical value for coronary artery wall imaging.</p>

Neovascularization in the carotid atherosclerotic plaque is not associated with inflammatory cell aggregation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Monocytes and macrophages in atherosclerotic plaque lead to plaque instability. The aim of the study was to determine if plaque neovascularization led to inflammation.</p><p><b>METHODS</b>Patients were consecutively enrolled if their carotid intimal media thickness was > 2 mm, as revealed by duplex ultrasound. The patients then underwent dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and fluorine-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography combined with computed tomography (PET CT). A target to background ratio (TBR) of ≥ 1.25 or < 1.25 served as the cutoff point for the presence and absence of inflammation, respectively.</p><p><b>RESULTS</b>Twenty-six patients underwent bilateral carotid DCE MRI and 24 patients also underwent PET CT. One hundred and fifty-five plaques were evaluated by both DCE MRI and PET CT. There was no significant difference in plaque morphology between the TBR ≥ 1.25 (n = 61) and TBR < 1.25 (n = 94) groups. No significant differences were found in plasma volume and transfer constant between the TBR ≥ 1.25 and TBR < 1.25 groups.</p><p><b>CONCLUSION</b>Our study did not find a significant correlation between plaque neovascularization and the aggregation of inflammatory cells.</p>

Synthesis and biological evaluation of novel diphenyl methane sulfinyl and diphenylthio-acetamide derivatives / 药学学报

According to the structure-activity relationships (SARs) of modafinil, a therapeutic drug of hypnolepsy, we designed and synthesized two series of compounds 2-[(diphenylmethane)sulfinyl] acetamides and 2-[(diphenylmethyl)thio] acetamides, and measured their biological activities. The target compounds (6a-6o) were synthesized beginning with diphenyl carbinol by substitution, oxidation, acylation and so on. Their structures were confirmed by ESI-MS, 1H NMR and elemental analysis. The central stimulatory effects of the target compounds were determined by the independent activity assay on mice. Compounds 6c, 6f and 6n have considerable activities, while the central stimulative effect of 6h is slightly better than the positive control modafinil.

Diagnostic value of MRI and MR arthrography in the detection of injuries of anterior labrum in shoulder / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the diagnostic value of MRI and MR arthrography in the detection of injuries of anterior labrum in shoulder and to evaluate the accuracy of MR arthrography in the classification of anterior labrum lesion.</p><p><b>METHODS</b>Seventy-eight patients with arthroscopically proved anterior labrum lesions(study group) and 75 patients with arthroscopically proved intact anterior labrum (control group) from January 2007 to December 2010 were included to the study. All patients underwent MRI and MR arthrography at our institution prior to shoulder arthroscopy. All MRI and MR arthrography were analyzed by one musculoskeletal radiologists and one sports medicine surgeon who had no knowledge of the clinical histories and arthroscopic results. The same classification system of labrum lesions based on arthroscopy was used in image analysis. Imaging findings and arthroscopic findings were compared in all patients. With arthroscopy used as the standard of reference, the sensitivities, specificities and accuracies of MRI and MR arthrography in the detection of anterior labrum lesions were compared, and the sensitivities, specificities and accuracies of MR arthrography in the correct classification of anterior labrum lesions were calculated.</p><p><b>RESULTS</b>In arthroscopy, 78 anterior labrum lesions, 67 rotator cuff lesions and 8 SLAP lesions were diagnosed, for the detection of anterior labrum lesions, the sensitivity of MRI and MR arthrography was 80.8% and 92.3%,the specificity was 89.3% and 97.3%,the accuracy was 85.0% and 94.8% respectively. Seventy-eight patients with arthroscopically proved anterior labrum lesions included 39 Bankart lesions, 32 ALPSA lesions and 7 Perthes lesions, with MR arthrography, Bankart, ALPSA, and Perthes lesions were correctly classified in 84.6%, 84.4%, and 57.1% of cases, respectively.</p><p><b>CONCLUSION</b>MR arthrography has a higher sensitivity, specificity and accuracy than MRI in the detection of anterior labrum injuries. MR arthrography was useful in the classification of different variants of anterior labrum injuries before operations. It may directly influence the surgeon's strategy and is useful in preoperative planning of arthroscopic reconstructions.</p>

Role of transrectal real-time tissue elastography in the diagnosis of prostate cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the role of transrectal real-time tissue elastography (TRTE) in the diagnosis of prostate cancer (PCa).</p><p><b>METHODS</b>Eighty-four patients with suspected PCa and scheduled for prostate biopsies underwent TRTE, digital rectal examination (DRE), transrectal ultrasonography (TRUS), and magnetic resonance imaging (MRI). The findings of TRTE were compared with those of other examinations and pathological findings.</p><p><b>RESULTS</b>Of these 84 patients, 36 had benign lesions and 48 had PCa. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 91.7%, 72.2%, 83.3%, 81.5%, and 86.7% for TRTE and 85.4%ì63.9%ì76.2%, 75.9%, and 76.7% for TRUS (P>0.05), while its specificity (72.2%) was significantly higher than that of MRI (44.4%) (P=0.03). The TRTE findings were not significantly correlated with the pathological findings and serum total prostate specific antigen (P>0.05), and the diagnostic sensitivity of TRTE decreased along with the enlargement of prostate. However, the diagnostic specificity of TRTE was higher than MRI for nodules with soft to medium texture (P=0.04).For PCa, the diagnostic sensitivity of TRTE increased when the Gleanson scores of tumors increased (P<0.05).</p><p><b>CONCLUSION</b>TRTE can be used as a diagnostic test to supplement clinical diagnosis of PCa.</p>

MR image-guided anterior direct arthrography of the shoulder / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the method of MR guided anterior direct arthrogaphy of shoulder and its clinical applications.</p><p><b>METHODS</b>From 2008.4 to 2008.10, 40 patients with rotator-cuff tear (29 males and 11 females, ranging in age from 22 to 70 years, with an average of 35 years) underwent MR guided anterior direct arthrogaphy of shoulder, so as to diagnosis shoulder wound. The results were compared to that of arthroscopy.</p><p><b>RESULTS</b>Shoulder arthrography showed lesons in 36 patients, and failure in 2 patients, including contrast media extravasation in 1 patient, and gas entry to joint cavity in 1 patient. Two patients showed no rotator cuff injuries. Twenty-eight patients were confirmed by arthroscopy as rotator-cuff injured in different degree. Twenty-six patients were confirmed injuries by both arthroscopy and MR guided anterior direct arthrogaphy.</p><p><b>CONCLUSION</b>MR guided anterior direct arthrogaphy of shoulder as a minimally invasive method in displaying the rotator-cuff tear has higher accuracy and wide clinical application prospect.</p>

Feasibility of whole body diffusion weighted imaging in detecting bone metastasis on 3.0T MR scanner / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison.</p><p><b>METHODS</b>Forty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed.</p><p><b>RESULTS</b>A total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-based specificity and NPV of whole body DWI were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%).</p><p><b>CONCLUSION</b>Whole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.</p>

Compensatory responses induced by oxidative stress in Alzheimer disease

Oxidative stress occurs early in the progression of Alzheimer disease, significantly before the development of the pathologic hallmarks, neurofibrillary tangles and senile plaques. In the first stage of development of the disease, amyloid-â deposition and hyperphosphorylated tau function as compensatory responses and downstream adaptations to ensure that neuronal cells do not succumb to oxidative damage. These findings suggest that Alzheimer disease is associated with a novel balance in oxidant homeostasis.