People departure from the treatment, prevention and health care purposes, intermittently or continuously excessive use of drugs with dependence, will cause serious mental and physical damage, while serious social harm.Opioids are the most commonly abused drug, abusers by taking an excess number of pills orally or by crushing the pills, followed by smoking, snorting, or injecting the new altered formulation to get euphoric.The escalating abuse of opioids has recently spawned the development of novel drug formulations resistant to various methods of tampering and misuse.This article discusses available opioids that include abuse-deterrent mechanisms as well as such agents currently in development.

Long non-coding RNA (lncRNA) is defined as non-protein coding transcript longer than 200 nucleotides. In the form of RNA, it affects gene expression at the epigenetic, transcriptional and post-transcriptional levels, and is widely involved in the body's pathophysiological processes. This review summarizes the research progress of lncRNA in the field of parasitology in order to find new targets for the prevention and treatment of parasitic diseases.

Objective To compare and analyze the synchrony of cardiac contraction when left bundle branch area pacing ( LBBP ) using tissue Doppler imaging ( TDI ) . Methods T wenty‐four patients with LBBP and 20 patients with right ventricular pacing ( RVP ) were enrolled in the study . Among them , 35 cases were diagnosed as sick sinus syndrome ( SSS ) and 9 cases were diagnosed as Ⅱ or Ⅲ degree atrioventricular block ( AVB) before operation . Echocardiographic images were collected with ventricular pacemaker‐on ,and patients with SSS in LBBP group under the condition of pacemaker program control also collected the image of self‐conduction . TDI was used to measure time of the peak velocity ( T s ) of myocardial contraction in the left ventricular 12 segments ,right ventricle 2 segments ,and atrial 3 walls .The difference between the basal segment of left ventricular lateral wall and right ventricular free wall ( T s‐LV‐RV ) ,the mean value of the right ventricular 2 segments ( T s‐2‐RV ) ,the average( T s‐12‐LV ) and standard deviation ( T sd‐12‐LV ) of the left ventricular 12 segments ,and the difference in peak systolic time among 3 walls T AL‐R ,T AI‐R ,T AL‐I were calculated . Results Compared with the RVP pacing state ,the parameters of left ventricular systolic synchrony in LBBP pacing were shortened ,and the difference was statistically significant ( P ＜ 0 .05 ) . T here was no significant difference in parameters of left ventricular/right ventricular systolic synchrony and cardiac function between the LBBP group and the self‐conduction status ( P＞0 .05) . Conclusions Left ventricular systolic synchrony is superior to RVP in LBBP pacing ,and left/right ventricular systolic synchrony and cardiac function are not different from self‐conduction . LBBP is a new physiological pacing . TDI is able to quantitatively assess cardiac systolic synchrony .

Objective:To investigate the difference in the peri-coronary fat attenuation index (FAI) between using coronary calcium score (CCS) images and coronary CT angiography (CCTA) images, and to explore the feasibility and befitting threshold of FAI measured on CCS images.Methods:The clinical and imaging data of patients who underwent CCTA examination from August 2019 to August 2020 were retrospectively analyzed in the First Affiliated Hospital of Soochow University. According to the inclusion and exclusion criteria, there were 122 cases in non-calcified plaque group (144 coronary arteries) and 97 cases in none-plaque group (186 coronary arteries). The coronary arteries were delineated both on CCS and CCTA images with Perivascular Fat Analysis Tool; the regions of interest of peri-coronary adipose tissue were generated automatically after setting the threshold of fat tissue. Then the FAI value was calculated. The thresholds were set in four levels (-190--30, -185--25, -180--20 and -175--15 HU) for CCS images and one level (-190--30 HU) for CCTA images. The intra-class correlation coefficient (ICC) was used to evaluate the consistency of the measurements of FAI values on CCS and CCTA images between the two physicians. Paired t test was used to compare the differences of FAI values between CCS and CCTA images, and Pearson correlation coefficient was used to evaluate the correlation between CCS-FAI and CCTA-FAI. Results:(1) FAI values measured on CCS and CCTA images by 2 physicians showed good consistency; (2) At the threshold of -185--25 HU, there was no significant difference in FAI values between the CCS and CCTA images for non-calcified plaque group [(-84.15±5.99)HU vs. (-83.83±5.98)HU, t=0.79, P=0.429], as well as for the none-plaque group [(-83.41±5.75)HU vs.(-83.84±6.25)HU, t=-1.08, P=0.280]; (3) There were significant differences on FAI values between the CCS images and CCTA images at the threshold of -190--30、-180--20 and -175--15 HU (all P<0.05); (4) There were moderate correlations on FAI values between the CCS images and CCTA images under different thresholds both in non-calcified plaque group and none-plaque group. Conclusion:It is feasible to measure FAI on CCS images, and the befitting threshold is -185--25 HU.

This paper reported a case of a 29-year-old male patient with mental disorder caused by prion disease was misdiagnosed as depressive episode with somatic symptoms. The patient's symptoms were initially predominantly psychiatric， with progressive worsening of somatic symptoms， and he died more than 1 year after his first onset. Prion disease caused various manifestations of mental symptoms， which can easily lead to missed diagnosis and misdiagnosis. This paper discussed the case， in order to provide references for the clinical diagnosis of mental disorder caused by prion disease.

INTRODUCTIONStruma ovarii represents about 1.0% of all ovarian tumours. While management involves surgery, there is a paucity of data regarding the extent and approach of surgery, and postoperative management. This study aimed to delineate the management of struma ovarii, its associated complications, and postoperative follow-up and investigations.

METHODSWe retrospectively reviewed cases of benign struma ovarii treated at KK Women's and Children's Hospital, Singapore, between January 2000 and May 2011.

RESULTSA total of 68 patients underwent surgical removal of ovarian cyst or mass (24 cystectomy, 20 salpingo-oopherectomy and 24 total hysterectomy and bilateral salpingo-oopherectomy). Of the 68 surgeries, 39 (57.4%) included intraoperative frozen section sampling or procedures for staging of ovarian malignancy. The majority (73.5%) of surgeries were laparotomies. Histology revealed benign struma ovarii in all (98.5%) but one patient. Only 7 (10.3%) patients had postoperative complications - 3 wound-related, 2 thyroid-related, 1 incisional hernia and 1 nonspecific. The mean length of hospital stay was 4.2 days. During follow-up, 45 (66.2%) patients required no additional investigations. The most common investigation done was ultrasonography (n = 18, 26.5%). While no recurrences were diagnosed histologically, two patients were subsequently found to have complex/dermoid ovarian cysts on the ipsilateral side of the previous struma ovarii on ultrasonography.

CONCLUSIONSimple surgery is recommended for patients with struma ovarii, especially if they have fertility potential. Laparoscopic surgery is the recommended approach due to its shorter recovery time and lower morbidity. Most patients do not require extended periods of follow-up or postoperative investigations.

Cystectomy ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Laparoscopy ; Length of Stay ; Middle Aged ; Neoplasm Recurrence, Local ; surgery ; Ovarian Neoplasms ; diagnosis ; surgery ; Ovariectomy ; Ovary ; pathology ; Postoperative Period ; Retrospective Studies ; Salpingectomy ; Singapore ; Struma Ovarii ; diagnosis ; surgery

Objective To compare the effects of dobutamine with those milrinone on myocardial strain in patients undergoing valve replacement surgery.Methods Fifty-five patients udergoing valve replacement surgery, 27 males and 28 females, aged 40-75 years, falling into ASA physical statusⅡ orⅢ, New York Heart Association (NYHA) ⅡorⅢ, were included in this study.They were divided into 3 groups by using a random number table:intravenous infusion dobutamine group (group D, n=18), intravenous infusion milrinone group (group M, n=20) and intravenous infusion saline group (group C, n=17).All patients were used general anesthesia.In groups D, the patients received intravenous infusion dobutamine (4μg·kg-1·min-1) for an hour starting from 15 min after termination of CPB.In group M, the patients did intravenous infusion milrinone (0.4μg·kg-1·min-1) in the same way.In group C, the patients got intravenous infusion saline also.After induction of anesthesia, these patients were recorded for hemodynamic measurement at three points after induction of anesthesia and before splitting of sternum (T0), starting from 15 min after termination of CPB (T1), intravenous infusion medicine for 30 min (T2), intravenous infusion medicine for one hour (T3):HR, CVP, cardiac output (CO), left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), cardiac index (CI) and systemic vascular resistance index (SVRI) and strained indicator:global longitudinal strain of left ventricle (S-LVL), global circumferential strain of the left ventricle (S-LVM), global longitudinal strain of right ventricle (S-RV).Results Compared with group M, HR in group D at T2 and T3 was higher (P<0.05).Compared with group C, HR in group D at T3 was higher (P<0.05).And CI in group D at T2 was higher than that in groups C and M (P<0.05).Compared with groups C, S-LVMin groups D and M at T2 and T3 were stronger, S-LVL, S-RV in group D and S-RV in group M at T3 were stronger (P<0.05).Conclusion Intravenous infusion dobutamine can improve S-LVM, S-LVLand S-RV;Intravenous infusion milrinone can improve S-LVMand S-RV.

Objective To evaluate the effect of dobutamine or milrinone on intraventricular syn-chronization in the patients undergoing cardiac valve replacement with cardiopulmonary bypass ( CPB). Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 40-75 yr, of New York Heart AssociationⅡorⅢ, scheduled for elective cardiac valve replacement with CPB, were divided into 3 groups (n＝20 each) using a random number table: control group ( group C), dobutamine group ( group D) and milrinone group ( group M). Dobutamine 4 μg·kg-1·min-1was intravenously infused for 60 min starting from 15 min after termination of CPB in group D. Milrinone 0. 4 μg·kg-1·min-1was intravenously infused for 60 min starting from 15 min after termination of CPB in group M. The equal volume of normal saline was given instead in group C. The parameters of heart function were monitored using transesophageal echocardiography. After induction of anesthesia and before splitting the sternum (T0), at 15 min after termination of CPB (T1), and at 30 and 60 min of dobutamine, milri-none or normal saline infusion (T2, average value at two time points), the parameters of intraventricular synchronization were calculated with QLAB software (9. 1 version): standard deviation of time to peak sys-tolic velocity of the left ventricular longitudinal strain 7 segments (LVSDt-L), standard deviation of time to peak systolic velocity of the right ventricular longitudinal strain 7 segments (RVSDt), standard deviation of time to peak systolic velocity of the left ventricular circumferential strain 6 segments (LVSDt-C). Results Compared with group C, LVSDt-C, LVSDt-L and RVSDt were significantly decreased at T2in group D (P＜0. 05), and no significant change was found in the indices mentioned above at each time point in group M (P＞0. 05). RVSDt was significantly higher at T2in group M than in group D ( P＜0. 05). Compared with the baseline at T0, LVSDt-L was significantly increased at T2in group C, and RVSDt was significantly in-creased at T2in group M ( P＜0. 05). Conclusion Intravenously infusing dobutamine after CPB can im-prove the ventricular synchronization, however, intravenously infusing milrinone may increase the right ventricular asynchronization in the patients undergoing cardiac valve replacement.

Objective To evaluate the changes of left ventricular hemodynamics and systolic function in patients with apical aneurysm after percutaneous ventricular restoration ( PVR) by echocardiography . Methods Fifty patients with apical aneurysm were divided into PVR group ( 25 cases) and conservative treatment group ( control group ,25 cases ) . Two-dimensional transthoracic echocardiography ( 2D-TTE ) combined with real-time three-dimensional transesophageal echocardiography( RT-3DTEE) were applied for all the subjects in PVR group on preoperative ,one week after operaction ,three months after operaction and in control group on initial stage of prevent ventricular remodeling therapy ,one week after therapy ,three months after therapy to obtain left ventricular end-diastolic diameter( LVEDD) ,left ventricular end-systolic diameter( LVSDD) ,left ventricular end-diastolic volume( EDV ) ,end-systolic volume( ESV ) ,left ventricular ejection fraction( LVEF) ,left ventricular fractional shortening ( LVFS ) ,body surface area ( BSA ) ,stroke volume( SV) ,stroke volume index ( SVI) ,cardiac output ( CO ) ,cardiac output index ( CI) . Results There were significant differences in all parameters( P < 0 .05) especially in LVEF and SVI( P < 0 .01) between PVR group and control group in the following three months after operaction ,while there was no significant difference of the following one week after operaction( P > 0 .05) .Compared with preoperative ,there was no difference in all parameters in the following one week after operaction ( P > 0 .05) ,there was significant increase in SV and significant reduce in LVEDD and EDV ( P < 0 .01) between preoperative and in the following three months after operaction ,while there was no significant difference between preoperative and in the following one week after operaction ( P > 0 .05 ) .For the control group there was no significant difference between initial stage of prevevt ventricular remodeling therapy and in the following one week or three months after operaction .Conclusions PVR has a definite effect on left ventricular hemodynamics and systolic function in patients with apical aneurysm in the short term ,while 2D-TTE and RT-3DTEE provides a reliable basis for clinical to evaluate the effect of the PVR .

Objective:To assess the changes of left ventricular systolic function and global synchronization and myocardial work in patients with left bundle branch pacing (LBBP) by two-dimensional multi-layered speckle tracking imaging.Methods:Forty-two patients with Ⅱ degree Ⅱ type or Ⅲ degree atrioventricular block (AVB) in the Cardiovascular Hospital of Xiamen University from April to December 2019 were selected as pacing group, which were further divided into two groups according to different pacemaker modes: twenty patients with right ventricular septal pacing (RVSP), twenty-two patients with LBBP, and twenty patients with normal ECG and cardiac structure were enrolled as control group. Echocardiography of pacing group and control group was performed and analyzed. The left ventricular subendocardial longitudinal strain peak(LSendo), the middle layer myocardial longitudinal strain peak(LSmid), subepicardial longitudinal strain peak(LSepi), global myocardial longitudinal strain peak(GLS), peak strain dispersion (PSD), global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were acquired. The differences among the three groups were analyzed and the high difference indexes were screened by statistical modeling.Results:LSendo in three groups had no difference ( P>0.05). LSmid, LSepi, GLS in the control group, LBBP group and RVSP groups were decreased gradually ( P<0.05). GLS in LBBP group was higher than in RVSP group ( P<0.05). Compared with the control group, the increases of QRS and PSD in LBBP group were not statistically significant ( P>0.05), while the decreases of QRS and PSD in LBBP group were statistically significant compared with the RVSP group ( P<0.05). The values of GCW among three groups had no statistical significance ( P>0.05). Compared with the control group, the decrease of GWI in LBBP group was not statistically significant ( P>0.05), while the increase of GWW and the decrease of GWE were statistically significant ( P<0.05). Compared with the RVSP group, the increases of GWI and GWE and the decrease of GWW in LBBP group were statistically significant ( P<0.05). QRS, LSendo, GLS, LSmid, left ventricular apex rotation to basal rotation peak time(ApexBase period) were the indexes with significant difference among LBBP and RVSP groups and all index characteristics showed better in LBBP than RVSP group. Conclusions:Two-dimensional multi-layered speckle tracking imaging can be used to evaluate the effect of LBBP on left ventricular systolic function and global synchronization and myocardial work. LBBP longitudinal mechanical synchronization is better than right ventricular septal pacing by improving the peak global myocardial longitudinal strain and myocardial work after pacemaker.