Classification of peroneal muscle trochlear and its correlation with calcaneus / 解剖学报

Objective To measure and classify the trochlear size of fibular muscle, and to analyze its correlation with calcaneus. Methods In 824 calcaneal specimens, the length, width and height of the peroneal muscle trochlear were measured and classified according to the four types of flat, convex, concave and tunnel. Results The prevalence of the peroneal tubercle was 62. 5%. The average length, width, and height of the tubercle were ( 11.5±3.32) (2.56-23.14) mm, (6.27±2.20) (1.34-14.99)mm, and (2.69±1.30) (0.41-8.18)mm respectively. The four types of peroneal tubercle were classified as flat in 191 (37.09%), prominent in 189 (36.7%), concave in 131 (25.44%), and tunnel in 4 (0.77%). Conclusion This data may help understand pathology of peroneus tendon and its relationship with peroneal tubercle, and it may help make standard to define the abnormal peroneal tubercle.

Application of Sarcosaprophagous Insects to Estimate the Postmortem Interval in 11 Cases / 法医学杂志

Objective To test the feasibility and accuracy of with sarcosaprophagous insects postmortem interval （PMI） estimation with sarcosaprophagous insects and provide references for estimation practice. Methods Eleven cases confirmed by the detection results, with complete entomological evidence were selected. The insect species, estimation results and true results involved in the cases were statistically analyzed and compared. Results Thirteen species of insects were found at the criminal scene, including Chrysomya megacephala （Fabricius）, Chrysomya rufifacies （Macquart）, Chrysomya nigripes （Aubertin）, Lucilia sericata （Meigen）, Hydrotaea spinigera Stein, Muscina stabulans （Fallén）, Sarcophagid （species were not identified）, Megaselia scalaris （Loew）, Hermetia illucens （Linnaeus）, Saprinus splendens （Paykull）, Creophilus maxillosus （Linnaeus）, Dermestes maculatus （De Geer） and Necrobia ruficollis （Fabricius）. The PMI of all eleven cases was within the range of estimated PMI. The estimated results of 72.73% cases were on the same day of the true results. Conclusion Sarcosaprophagous insects can estimate the PMI simply and conveniently. In cases where the PMI is within the time range of one generation of flies or beetles, the estimation results are relatively accurate. However, the estimation is less accurate when the PMI is beyond the time range.

Anatomy of the safe zone of sustentaculum tali screw fixation / 解剖学报

Objective To explore the safe zone of sustentaculum tali screw fixation in treatment of calcaneal fracture. Methods Morphologies of sustentaculum tali in intact dry calcaneus of 589 Chinese adult were investigated and classified. The clinically significant data were observed and measured in sustentaculum tali and calcaneus. Results Type B calcaneus (77. 92%) was defined as the most common type, and type A calcaneus (21. 73%) was the second most common type. There were two osseous marks in the medial surface of sustentaculum tali: the posterior tip of middle articular surface for talus and the front end of medial margin of groove for flexor hallucis longus. In the medial of sustentaculum tali, the each side length of quadrilateral was (8. 07±1. 33)(3. 88-12. 31)mm, (10. 27±1. 57)(5. 62-15. 91) mm, (14. 99± 2. 33) (5. 86-21. 87) mm and (15. 43±2. 16) (9. 82-22. 70) mm, respectively. The length of the its diagonal line was (15. 83±2. 94) (3. 83-26. 59) mm. The length of middle articular surface for talus was (18. 97±2. 85)mm (9. 90-25. 41). Conclusion The quadrilateral in the medial surface of sustentaculum tali is the safe zone for sustentaculum tali screw fixation in treatment of calcaneal fracture.

Anatomical basis in the treatment of sinus tarsi syndrome by local steroid injection / 解剖学报

Objective To provide anatomical basis for the treatment of sinus tarsi syndrome by developing the anatomical structure of sinus tarsi. Methods Thirty formalin fixed lower limb specimens were dissected. The anatomic structures of the sinus tarsi, neurovascular tissue, ligament and adipose tissue were observed and measured. Morphologies of the sinus tarsi and canal of tarsus in intact dry calcaneus and talus of 136 Chinese adult specimens were investigated and measured. Results The artery of the sinus tarsi and its periphery issued from the dorsalis pedis artery, anterior medial malleolar artery, perforating peroneal artery and lateral tarsal artery. The laterosuperior point of cuboidal articular surface of calcaneus was the obvious osseous marks of the lateral surface of sinus tarsi. The length canal of tarsus, sinus tarsi and the calcaneal sulcus were (14. 85 ±2. 08) ( 8. 33-22. 00) mm, (26.38±3.05) ( 16. 54-35. 79) mm and (41. 25 ± 3. 52) (31. 06-53. 92) mm respectively. There was a angle between two axes of calcaneus and tarsal canal, which was (49. 37± 4.76) (39. 18~56.37)°. Conclusion During the treatment of sinus tarsi syndrome by the local steroid injection, the laterosuperior point of cuboidal articular surface of calcaneus should be palpated firstly, which is the point of inserting the needle. Then, the injection needle is towards posteromedial at 49°, and advance 2.5 mm to touch the sinus tarsi.

Clinical and genetic analysis of four patients with congenital neutropenia / 中华医学遗传学杂志

OBJECTIVE@#To delineate the clinical feature and genetic basis of four patients with congenital neutropenia.@*METHODS@#All patients were subjected to whole exome sequencing (WES). Suspected variants were verified by Sanger sequencing.@*RESULTS@#The patients (two boys and two girls), aged 7 to 15 months, suffered from neutropenia and recurrent infections. Bone marrow smears showed a significant decrease in the proportion of rod-shaped and lobulated granulocytes, which suggested impaired development and maturation of bone marrow neutrophils. WES has discovered heterozygous variants (c.496G>A, c.58C>G, c.391G>A and IVS1+5T>A) of the ELANE gene in the patients. Among these, c.58C>G and IVS1+5T>A were unreported previously. Follow up revealed patients 1 and 3 had periodic neutropenia, while patients 2 and 4 had severe congenital neutropenia. After attaining the definite diagnosis, the patients were treated symptomatically.@*CONCLUSION@#The main clinical feature of congenital neutropenia is refractory recurrent bacterial infections, for which mutations of the ELANE gene are a common cause. Two novel pathogenic ELANE variants have been discovered in this study.

Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus / 华西口腔医学杂志

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

Development of portable device for wound perfusion and negative-pressure therapy / 医疗卫生装备

Objective To develop a portable device for wound perfusion and negative-pressure therapy to solve the problem of the existing one.Methods The device used a unified waste liquid tank/liquid reservoir as the infrastructure,and had its reservoir and waste liquid bags made of flexible materials.Dynamic isolation between the reservoir bag and waste liquid bag was realized by a separator.Wound perfusion was implemented by the gravity of the waste liquid and the elastic force of the spring, and negative-pressure therapy was carried out by the elastic force and vacuum pump. The SCM regulated the switching of the electromagnetic valve according to the information from the flow meter and pressure sensor so as to perform quantitative wound perfusion, stable negative-pressure therapy and switching between the functions of perfusion and negative-pressure therapy.Results The device volume was decreased by regulating dynamically the sizes of reservoir and waste liquid bags,and the power consumption was also reduced by using liquid gravity and spring force. Conclusion The wound perfusion and negative-pressure therapy device gains advantage over the existing one in portability, and thus is of significance for promoting the technology of wound perfusion and negative-pressure therapy.

Pathological changes of the skeletal muscle after loca loosening therapies / 中国组织工程研究

BACKGROUND: Local soft tissue lysis has been widely used in clinical rehabilitation treatment of chronic soft tissue injuries, and has achieved certain clinical outcomes. However, it is an invasive treatment, and there is little information about the pathological changes and prognosis of the local tissues post-treatment. OBJECTIVE: To observe the repair process and pathologic changes of the muscles after local soft tissue lysis with several needles. METHOD:Songjin-needle,Yinzhi-needle,Changyuan-needle,Xiaozhen-needle,Ren-needle and Pi-needle were inserted into the belly of rat gastrocnemius gastrocnemius with a depth of 0.5-1.0 cm, twice or thrice. Then the rats were killed at 3, 7, 14, 21 and 30 days after acupuncture. The corresponding parts of tissues were removed and fixed with paraformaldehyde, and stained with hematoxylin and eosin and immunohistochemistry to observe the histomorphological features and pathological changes under light microscope. The CellSens-Entry 1.15 software was used for image acquisition, and the number of fibroblast cells and microvessel density were calculated. The integral absorbance values of collagen type Ⅰ were calculated by Image Pro plus 6 software. RESULTS AND CONCLUSION: On day 3 after intervention, muscle fiber dissolution, necrosis and inflammatory cell infiltration were visible. On day 7, there was a reduction in inflammatory cells, fibroblast activation and proliferation, and granulation tissue hyperplasia. On day 14, there was local accumulation of collagen with substantial granulation tissues. On day 21, collagen fibers decreased and granulation tissues organized. On day 30, there was local scar formation. Immunohistochemical staining results showed that there was collagen type Ⅰ in the surgical area after intervention. The microvessel density, fibroblast count and integral absorbance value increased firstly and then decreased, which showed significant differences among groups (P < 0.01). These findings imply that the new types of needles for local soft tissue lysis do certain damage to the gastrocnemius muscle, and the inflammatory changes of the local tissue and granulation tissue organized will result in local scar formation after loosening therapies.

Osteopractic total flavone promoting rat extra-articular tendon-bone healing through mTOR pathway / 中国骨伤

<p><b>OBJECTIVE</b>To explore function and related molecular mechanism of osteopractic total flavone (OTF) on tendon healing in rats.</p><p><b>METHODS</b>Ten male rats aged for 8 weeks were collected and weighted from 180 to 220 g. Tendon stem cells were cultivated, the third tendon stem cells were used for experiment. OTP treated with 0, 0.1, 1, 10 ng/ml were added into tendon stem cells, and expression change of ALP, Runx2, OCN, VEGF, P-S6, P-4E/BP1 were detected after 14 days. Forty male rats aged for 8 weeks (weighted 180 to 220 g) were established extra-articular tendon-bone transplanting healing model, and divided into experimental group and control group. Experimental group were treated with OTF(100 mg·kg⁻¹·d⁻¹), while control group was treated by normal saline with the same volume. Tendon-bone healing degree were detected by biomechanical testing at 3 and 6 weeks after surgery, histological detection were applied to detect tendon-bone healing and number of new vessles.</p><p><b>RESULTS</b>After treated by OTP, ALP staining and active index detection showed there were statistical differences among 0, 0.1, 1, 10 ng/ml group. After 14 days' cultivation, western blotting results showed mTOR downstream marker protein P-S6 protein expression were gradually increased with increase of density of OTP, expression of P-4E/BP1 was reduced, while expression of Runx2, OCN, VEGF were increased. Biological detection results showed that there was no significant difference in mechanical strength between experimental group(0.78±0.05) N/mm and control group (0.51±0.02) N/mm at 3 weeks after surgery, while mechanical strength in experimental group (1.36±0.09) N/mm was higher than control group (1.01±0.08) N/mm at 6 weeks after surgery. Histological results showed maturity of tendon-bone surface cell were higher at 3 and 6 weeks in experimental group, sharpey fiber growth more density, calcification extent of mesenchyme was high, and new bone, vessels were increased.</p><p><b>CONCLUSIONS</b>OTF could promote osteogenic differentiation of tendon stem cells through mTOR signaling in vitro, and stimulate tendon-bone healing in bone tunnel and enhance connection quality between tendon and bone.</p>

Relationship between interleukins in the saliva and oral cavity cancer / 华西口腔医学杂志

Saliva is being attached great importance for its application in illness diagnosis and have more advantage on the diagnose in oral cavity cancer (OCC). Studies have showed that interleukin (IL) in the saliva could be used as a potential biomarker for OCC diagnosis. Moreover, they have a close connection with tumor genesis, invasion, and metastasis in OCC. Therefore, we reviewed research progress on the relationship between salivary interleukins and OCC.

Comparison of clinical efficacy between early low and high enteral nutrition (EN) administration in the early treatment of hyperlipidemic severe acute pancreatitis / 肠外与肠内营养

Objective: This study aimed to compare the effects of high versus low calorie early enteral nutrition (EEN) administration on the complications and prognosis of hyperlipidemic acute pancreatitis (HLAP) patients. Methods: In this study, HLAP patients were randomly divided into high calorie EEN group and low calorie EEN group. The nutritional support was carried out within 48h at patients' admission. The serum lipid levels, inflammatory parameters, the incidence of EN intolerance, hospitalization duration, ICU duration, the incidence of organ failure and infected pancreatic necrosis as well as mortality rate were recorded and compared between two groups. Results: 48 patients with diagnosis of HLAP were included in this study from January 2014 to June 2017. In the first two days, the serum lipid levels of patients in low-calorie group decreased gradually. The serum lipid levels of the two groups were 2. 3 (1. 7-3. 4) mmol/L versus 5. 2 (2. 9-6. 1) mmol/L (P = 0. 05) respectively on third day after EN administration. There was no significant difference in the incidence of MODS and mortality rate between the two groups while the ICU duration of low-calorie group was significantly shorter than that in high-calorie group. The incidence of IPN in low-calorie group showed an elevated trend but there was no statistical significance. Conclusion: For HLAP patients, low calorie-high protein nutrition supply could benefit the patients to gain lean body weight due to the positive nitrogen balance, and to consume body fat due to the deficiency of calories. It is an effective nutrition support strategy for the patients' recovery.

Epidemiology of opportunistic invasive fungal infections in China: review of literature / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To summarize the recent findings on the epidemiology of medically important, opportunistic invasive fungal infections (IFIs) in China and discuss the relevant social, economical reasons and medical factors.</p><p><b>DATA SOURCES</b>We performed a comprehensive search of both English and Chinese literatures of opportunistic IFIs from China up to April 2012.</p><p><b>STUDY SELECTION</b>Relevant literatures involving researches and cases/case series were identified, retrieved and reviewed.</p><p><b>RESULTS</b>The incidence of opportunistic IFIs in China was steadily increasing. The incidence and mortality of IFIs were different in patients with various underlying conditions/diseases, from 4.12% to 41.18% and 9.8% to 60.0%, respectively. Candida species, Aspergillus species and Cryptococcus neoformans species complex were the most frequent isolated pathogens. Other uncommon opportunistic IFIs were also been reported, including trichosporonosis, mucormycosis, hyalohyphomycosis (hyaline hyphomycetes) and phaeohyphomycosis (dematiaceous hyphomycetes). Reports of Chinese patients differed from those of many other countries as there were a higher number of patients without identifiable underlying diseases/conditions.</p><p><b>CONCLUSIONS</b>Because of the rapid economic development, changing population structure and a growing number of immunocompromised hosts with risk factors, today opportunistic IFIs in China have a significant impact on public health, associated with high morbidity/mortality and higher care costs. Now information related to the epidemiology of opportunistic IFIs in China is still sparse, so we need more organized groups of clinical scientists performing related researches to help the clinicians to obtain more accurate epidemiological characteristics.</p>

Ecological surveys of the Cryptococcus species complex in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Despite recent reports on the molecular epidemiology of cryptococcal infections in China, clinical isolates have been mostly reported from human immunodeficiency virus (HIV)-negative patients, and environmental isolates from China have rarely been included. The aim of this study was to investigate the ecological profile of Cryptococcus (C.) neoformans and C. gattii in China.</p><p><b>METHODS</b>A survey was performed in 10 cities from 20°N (North latitude) to 50°N and in a Eucalyptus (E.) camaldulensis forestry farm at the Guixi forestry center, China.</p><p><b>RESULTS</b>Six hundred and twenty samples of pigeon droppings from 10 cities and 819 E. camaldulensis tree samples were collected and inoculated on caffeic acid cornmeal agar (CACA). The brown-colored colonies were recultured to observe their morphology, growth on canavanine-glycine-bromothymol-blue (CGB) medium, phenol oxidase and urease activities, serotype and mating type. There were obvious differences in the positive sample rates of C. neoformans in pigeon droppings collected from the different cities, ranging from 50% in the cities located at latitudes from 30°N - 40°N, 29% at 20°N - 30°N and 13% at 40°N - 50°N.</p><p><b>CONCLUSIONS</b>There were no differences in positive bevy rates (approximately 80%) among the three grouped cities. Mycological tests of 101 isolates purified from pigeon droppings revealed that they were C. neoformans var. grubii. We also observed variable capsular size around the C. neoformans cells in colonies with variable melanin production and the bio-adhesion of the natural C. neoformans cells with other microorganisms. One urease-negative C. neoformans isolate was isolated from pigeon droppings in Jinan city. No C. gattii was isolated in this study.</p>

Disseminated cryptococcal lymphadenitis with negative latex agglutination test / 中华医学杂志(英文版)

We reported an unusual case of disseminated cryptococcal lymphadenitis in an immunocompetent host who presented with fever and lymphadenopathy, which were the only two symptoms and signs. Latex agglutination test of serum and cerebrospinal fluid (CSF) were negative, while lymph node biopsy showed Cryptococcus neoformans. A diagnosis of disseminated cryptococcal lymphadenitis was made. Then the patient was treated with amphotericin B for 15 days as initial therapy and itraconazole for 6 months as maintenance therapy respectively. The patient received re-examination per 6 months and was followed up for 2 years. Swollen lymph nodes diminished gradually, and no fever or other symptoms were found. Latex agglutination test of serum and CSF were negative throughout the follow-up period, and anti-HIV, syphilis and tuberculosis antibody were all negative.

Fungal infection after a tragedy: a report of three cases of candidosis in a fire accident / 中华医学杂志(英文版)

Patients who suffer severe burns are at increased risk for local and systemic infections. The incidence of fungal infections has increased in recent years, and these infections represent a major issue in burn intensive care units. Herein, we report three cases of fungal infection due to Candida species occurring in patients undergoing supportive therapy and antibiotic treatment during their hospitalization. Two of these patients were infected with Candida parapsilosis, and one was infected with Candida albicans. The risk factors for these patients' Candida infections were multiple and prolonged courses of antimicrobial treatment, steroid treatment, tracheal intubation and smoke inhalation. Susceptibility testing of nine antifungal compounds was performed, and the minimum inhibitory concentration (MIC) values of all isolated strains were lower than the breakpoint MIC value for resistance of the relevant drug. All three patients were cured by treatment with antifungal agents. Candida infection may occur 1 - 3 weeks after thermal injury, and the prompt recognition and treatment of such infections with antifungal therapies may result in decreased morbidity and mortality associated with these infections in burn patients.

Taxonomic analysis of cryptococcus species complex strain S8012 revealed Cryptococcus gattii with high heterogeneity on the genetics / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Initially, Cryptococcus (C.) neoformans was previously divided into two varieties comprising C. neoformans var. neoformans and C. neoformans var. gattii. Currently, taxonomic studies defined C. neoformans as C. species complex, which contains C. neoformans var. neoformans (serotype D), the hybrid isolates (serotype AD), C. neoformans var. grubii (serotype A) and C. gattii (serotypes B and C). However, Liao and his team once isolated a unique C. gattii isolate, namely strain S8012 with unique phenotype from cerebrospinal fluid (CSF) of a 43-year-old male patient in the Shanghai Changzheng Hospital and described as C. neoformans var. shanghaiensis in 1980s. The aim of this study was to explore the genetic background and polymorphism of Chinese clinical C. gattii isolates.</p><p><b>METHODS</b>S8012 was analyzed as representative strain using the M13-polymerase chain reaction (PCR) fingerprinting pattern and multilocus sequence analysis including internal transcribed spacers of rDNA (ITS region), the intergenic spacer 1 regions (IGS1), RPB1, RPB2, CNLAC1, and TEF1 genes.</p><p><b>RESULTS</b>The PCR fingerprinting pattern results showed strain S8012 belonged to molecular types VGI, and phylogenetic analysis suggested strain S8012 was grouped into the cluster of C. gattii environmental isolates originated from Eucalyptus camaldulensis trees in Australia.</p><p><b>CONCLUSION</b>C. gattii isolates from Chinese patients expresses high polymorphism on the phenotype, and molecular type VGI isolates from China have a close genetic relationship with the C. gattii isolates from Australia.</p>

Meta-analysis of laparoscopic and open repair of perforated peptic ulcer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To assess the safety and feasibility of laparoscopic and open repair of perforated peptic ulcer.</p><p><b>METHODS</b>Studies on comparison between laparoscopic repair(LR) and open repair(OR) of perforated peptic ulcer were collected. Data of operating time, blood loss, time to first flatus, postoperative hospital stay, postoperative complications and mortality between LR group and OR group were meta-analyzed using fixed effect model and random effect model.</p><p><b>RESULTS</b>Nineteen studies including 1507 patients were selected for this study,including laparoscopic surgery(n=673) and open surgery(n=834). There were significant differences in blood loss, time to first flatus, postoperative hospital stay, wound infection rate and mortality between LR group and OR group. However, no significant differences existed in operative time, postoperative sepsis, pulmonary infection, abdominal abscess, and suture leakage between the two groups.</p><p><b>CONCLUSIONS</b>Laparoscopic repair of perforated peptic ulcer is associated with improved outcomes in terms of less blood loss, quicker recovery, and lower rates of wound infection and mortality. Laparoscopic repair of perforated peptic ulcer is safe and feasible.</p>

Necessity of splenectomy in radical resection of gastric cancer: a meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the necessity of splenectomy in radical resection of gastric cancer.</p><p><b>METHODS</b>Twelve studies comparing outcomes after radical resection of gastric cancer with or without splenectomy were identified. Both fixed effect model and random effect model were used.</p><p><b>RESULTS</b>There were 2628 patients in total. There were significant differences in complications between splenectomy group and spleen-preserving group(OR=1.91, 95% CI:1.28-2.87, P<0.05), while no significant difference in 5-year survival rate was noticed(HR=0.90, 95% CI:0.73-1.11, P>0.05).</p><p><b>CONCLUSION</b>Radical resection of gastric cancer combined with splenectomy is not associated with improved survival but increased postoperative complications.</p>

Experimental study on pulp revitalization of Beagle dog's immature permanent teeth after pulpectomy / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To observe the process of pulp revitalization of immature permanent teeth after pulpectomy.</p><p><b>METHODS</b>Thirty-two single-rooted teeth with open apices from 4 Beagle dogs aged 4 months were included in the study. The pulpal tissues of 8 front teeth with single root of each dog were removed, and a blood clot was produced to the level of the cementoenamel junction followed by a double seal of mineral trioxide aggregate and composite resin. At day 7, 14, 21 and 28, respectively after operation, the dog was sacrificed, and then longitudinal paraffin sections were made for histologic investigation.</p><p><b>RESULTS</b>After 7 days, about one thirth of the pulp chamber had an ingrowth of new tissue. After 14, 21, 28 days, there were more and more new tissue in the chamber. This new tissue consisted of well-organized and well-vascularized connective tissue. Hard tissue was too observed in the root canal. In some cases, the newly generated hard tissue even deposited against the canal dentinal walls.</p><p><b>CONCLUSIONS</b>The pulp of immature permanent teeth can revitalize after removal of the original pulp tissue under suitable conditions.</p>

Nanoleakage at the resin-dental interface of four self-etching adhesives / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the nanoleakage and ultramorphology of four self-etching adhesives.</p><p><b>METHODS</b>Sixteen freshly extracted, caries-free human third molars were selected. A flat dentin surface was exposed by removing occlusal enamel. All teeth were randomly divided into four groups acorrding to four different self-etch adhesive: Adper Prompt (A), iBond (B), Xeno III (C) and SE Bond (D). The dentin were bonded with dentin adhesive system according to manufacturer's directions. Composite layers were built up incrementally. The specimens were sectioned longitudinally across the resin-dentin interface into 4.0 mm×0.9 mm sticks and then traced with ammoniacal silver solution. Epoxy resin-embedded sections were prepared for transmission electron microscope (TEM) to observe nanoleakage. The images were qualitatively compared by NIH software, and data was analyzed by SPSS.</p><p><b>RESULTS</b>Different thickness of hybrid layer and adhesives layer were observed for each adhesive. The hybrid layer of A, C was thicker than that of B, D, and adhesive layer of D was thicker than the others. The extent of nanoleakage varied among different adhesives: A (45.02 ± 9.49), B (43.97 ± 8.55), C (27.02 ± 10.86), D (12.94 ± 2.07). D presented significantly less silver deposition than any of the others did (P < 0.05).</p><p><b>CONCLUSIONS</b>The thickness of hybrid layer and adhesive layer vary among the four adhesives. The shape and extent of nanoleakage of each adhesive are also different. Two-step system shows less nanoleakage than one-step systems do.</p>