Objective To evaluate the curative effects and safty of contra-aperture dissection and skin bridge preservation in the treatment of low transphincteric perianal fistula.Methods Sixty subjects of low transphincteric perianal fistula were randomly divided into two groups.Thirty cases of treatment group were treated by contra-aperture dissection and skin bridge preservation,and 30 cases of control group were treated by anal fistulectomy.On the second,seventh and fourteenth day after operation,the postoperative pain,exudate and fever were recorded and scored.The curative time was observed.Anorectal dynamic changes were compared simultaneously to evaluate the curative effects and safety of contra-aperture dissection and skin bridge preservation.Results The scores of pain and exudate were significantly different between the treatment and the control group(P＜0.01).The wound-healing time was shorter in the treatment group than that in the control group((27.37±8.93) d vs.(32.73±9.45) d,P=0.000).There were significant differences in the anal resting pressure,anal maximal contraction pressure and active systolic pressure between the two groups (t =13.12,10.21,12.10;P＜0.01).There was no significant difference of total effect between the two groups(100％ and 93.3％;x2 =2.07,P＞0.05).Conclusion Contra-aperture dissection and skin bridge preservation can reduce postoperative pain,exudate and fever,shorten wound-healing time and protect anal functions in the treatment of low transphincteric perianal fistula.

OBJECTIVE:To compare the efficacy and safety of Leonurus artemisia cream and Dan’e fukang cream in the treat-ment of primary dysmenorrhea. METHODS:80 patients with primary dysmenorrheal were randomly divided into L. artemisia cream group (40 cases) and Dan’e fukang cream group (40 cases). L. artemisia cream group received L. artemisia cream 10 g, orally,twice a day. Dan’e fukang cream group received Dan’e fukang cream 10 g,orally,twice a day. The treatment was stated before 10 days of menstruation. 10 days was regarded as 1 treatment course,and it lasted for 6 courses. Cold drink and food were forbid during medication,washing face and feet with warm water,soaking feet with hot water if they can,paying attention to keep the lower abdomen and legs warm. If patients felt unbearable pain in menstruation,0.3 g Ibuprofen sustained release capsule was given,orally twice a day. Clinical efficacy,symptom score(dysmenorrhea degree,abdominal pain,lumbosacral pain)before and af-ter treatment,dysmenorrhea duration,frequency of taking painkillers and the incidence of adverse reactions in 2 groups were ob-served. RESULTS:There were no significant differences in the total effective rate and the incidence of adverse reactions in 2 groups (P>0.05). Before treatment,there were no significant differences in dysmenorrhea degree,abdominal pain,lumbosacral pain score,dysmenorrheal duration and frequency of taking painkillers in 2 groups (P>0.05). After treatment,the dysmenorrhea degree,abdominal pain,lumbosacral pain score in 2 groups were significantly lower than before,and Dan’e fukang cream group was lower than L. artemisia cream group with statistical sighificance(P<0.05),and dysmenorrheal duration and frequency of taking painkillers were significantly lower than before,with statistical significance(P<0.05),while there was no significant difference in 2 groups(P>0.05). CONCLUSIONS:Both L. artemisia cream and Dan’e fukang cream have good efficacy and safety in the treat-ment of primary dysmenorrhea,while Dan’e fukang cream is superior to L. artemisia cream in terms of improving clinical symp-toms.

Objective To observe the efficacy of Chinese herbal fumigant sitz bath for different exposure durations on patients for the complicatiors after mixed hemorrhoidectomy.Methods One hundred and twenty patients with mixed hemorrhoidectomy were randomized into four groups(2 treatment groups and 2 control groups) with 30 cases in each group.The treatment groups were treated with the Chinese Herbal fumigant sitz bath for 10 minutes and 15 minutes respectively;while the control groups were treated with the hemorrhoids lotion for 10 minutes and 15 minutes respectively.The severity of pain,edema,bleeding,constipation and urinary disturbance were scored on the second,seventh and fourteenth days after treatment.Data were analyzed statistically.Results Chinese herbal fumigant Sitz baths for 10 minutes could significantly reduce postoperative pain,edema and bleeding symptoms[(1.72±1.23) points,(0.72±1.25) points,(0.91±1.37) points,respectively,P ＜0.05],followed sequentially by groups of Chinese herbal fumigant Sitz baths for 15 minutes [(1.79±1.21)points,(0.89±1.28) points,(1.03±1.24) points]; The hemorrhoids lotion for 10 minutes ((1.86±1.25) points,(1.14±1.47) points,(1.49±1.56)) and 15 minutes[(2.03±1.48) points,(1.05±1.29) points,(1.39±1.47) points,respectively,P ＜ 0.05]With the successful cases of 27,21,18,and 6 in the groups,respectively.Though the overall response rates of for the groups of 10 min's treatment,15min's treatment and 10 min's control were not significantly different between each other(P =0.0634,P =0.2560),they showed a superior efficacy in the overall response rate to the 15 min's control group(P =0.0064,P =0.0365,P =0.0089),respectively.Conclusion Chinese herbal fumigant Sitz baths for 10minutes have a success rate of 100％ on alleviating complications after mixed hemorrhoidectomy.It has a prominent efficacy on reducing postoperative edema and bleeding symptoms than other treatments studied in this program.

Objective To evaluate radiofrequency ablation in anatomical hepatectomy.Methods The clinical data of 57 patients undergoing anatomical hepatectomy with radiofrequency ablation (radiofrequency ablation group) from Jul 2010 to May 2013 in Tangdu Hospital were compared with those 57 cases using traditional clamp crushing resection during the same period.Results There was no mortality perioperatively.Intraoperative duration of liver dissection,haemorrhage volume of liver dissection,blood transfusion volume,Pringle manoeuvre,postoperative alanine aminotransferase (ALT) in the third and fifth day in the radiofrequency ablation group were (65 ±30) min,(195 ± 107) ml,(150 ±80) ml,7 cases (12.3％),(309 ±226) U/L and (164 ±82) U/L respectively,which were statistically different from those of (50 ±40) min,(255 ± 180) ml,(205 ± 120) ml,45 (78.9％),(388 ± 174) U/L and (220 ± 156) U/L in clamp crushing resection group (seperately t =2.266,-2.158,-2.880,x2 =51.060,t =-2.090,-2.403,all P ＜ 0.05).Large branches of hepatic vein (caliber ≥ 7 mm) were injuried by mistake 7 times in radiofrequency group,there was no massive blood loss.Postoperative biliary fistula developed in two cases.There was no ablation included thrombus.In radiofrequency group,and Pringle manoeuvre was used in hemihepatic resection in 7 patients.Conclusions Radiofrequency ablation is not recommended to dissecting large caliber vessels (≥ 7 mm) for fear of causing thrombus.Radiofrequency ablation in anatomical hepatectomy,when used properly,is safe and effective.

Objective To investigate the correlation between the levels of placenta growth factor (PLGF),soluble angiopoietin receptor-2 (sTie-2) and critical coronary artery plaque imaging morphology of coronary borderline lesions in patients with coronary heart disease (CHD).Methods In three consecutive years from April 2007 to September 2009,a cohort of 719 patients with borderline coronary lesions with stenosis in three main vessels with lumen diameter reduction varied all the way from more than 20％ to less than 70％ and with greater than 2.25 mm of the inner diameter were selected in this study from 4 teaching hospitals of tertiary class A in Beijing.These patients fell into three categories:unstable angina pectoris (UAP,n =292),stable angina pectoris (SAP,n =219) and coronary arteriosclerosis (AS,n =208).The vessels involved were analyzed using quantitative coronary angiography (QCA).Plasma levels of PLGF and sTie-2 were measured by using protein chip.The relationship between plasma levels of vascular factors,sTie-2,PLGF and coronary artery plaque imaging morphology among three groups were analyzed.Results (1) Plasma level of PLGF was 80.33 ng/L in the UAP group,which was significantly higher than 54.29 ng/L in the SAP group and 45.16 ng/L in AS group (both P ＜0.05).Plasma level of sTie-2 was 1353.06 ng/L in the UAP group,which was significantly higher than 1308.28 ng/L in the AS group (P =0.008).(2) There was significantly statistical differences in QCA between the SAP group and the UAP group as well as the AS group (both P ＜ 0.05) in terms of the minimal lumen diameter,diameter stenosis rate,minimal lumen cross-sectional area and cross-sectional area of stenosis.The plaque area in the UAP group was larger than that in the AS group (P =0.013).(3) The relationship between vascular factors and plaque imaging morphology was analyzed.There was significantly statistical difference in the involved lesions among the three groups (P ＜ 0.01).(4) There was a positive correlation between plasma level of PLGF and minimal lumen cross-sectional area (r =0.493,P =0.009).Conclusions The plasma levels of PLGF and sTie-2 reflect the level of neo-vascularization in the plaque,and could be taken as predictive factors for potential pathogenesis of coronary plaque.

Medicine is a practical subject,which requires medical students to deepen and expand the understanding of the theory by clinical training,and establish clinical thinking.In our noviciate reform of obstetrics and gynecology,we have established the new problem-based teaching mode,which is an effective method in fostering the ability of information collection,innovation and practice,and have obtained more satisfactory results.

Objective:To investigate the role of LncRNA ZBED3-AS1 in osteoblast proliferation and differentiation in osteoporotic rats through regulating miR-339-5p/Notch 1.Methods:The rat models of sham operation (Sham) group and model (Model) group were established, and the bone mineral density (BMD) of rats was examined. Rat osteoblasts were isolated and the expression of ZBED3-AS1 and miR-339-5p was detected by qRT-PCR. The osteoblasts of rats in Sham group and Model group were divided into different groups and transfected. CCK8, alizarin red (AR-S) staining and alkaline phosphatase (ALP) staining were used to detect the proliferation and differentiation ability of cells in each group. The distribution of ZBED3-AS1 in cells was determined by FISH assay. Double luciferase report confirmed the relationship between ZBED3-AS1 and miR-339-5p as well as miR-339-5p and Notch 1.Western blot was used to detect the expression of Notch pathway related factors.Results:The bone mineral density of femur in Model group was significantly lower than that in Sham group ( P=0.0057) . Compared with Sham group, the expression of ZBED3-AS1 in osteoblasts of Model group was lower, while that of miR-339-5p was higher (all P<0.05) . Overexpression of ZBED3-AS1 could promote the proliferation and differentiation of osteoblasts, while knockdown of ZBED3-AS1 could inhibit the proliferation and differentiation of osteoblasts (all P<0.05) . ZBED3-AS1 could regulate miR-339-5p as ceRNA (all P<0.05) . Overexpression of miR-339-5p can inhibit the proliferation and differentiation of osteoblasts, which can be partially saved by overexpression of ZBED3-AS1. Notch 1 was confirmed as a target of miR-339-5p, at the same time, interfering with the expression of ZBED3-AS1/miR-339-5p can affect the expression of Notch-1 protein, and the regulation of ZBED3-AS1/miR-339-5p on osteoblasts may be realized through Notch pathway. Conclusion:ZBED3-AS1 can be used as ceRNA to regulate miR-339-5p, and then affect the proliferation and differentiation of osteoblasts in osteoporotic rats.

Objective:To explore the effect of Wnt/β-catenin signaling pathway on growth plate development of tibial growth plate in young chronic renal failure (CRF) rats.Methods:Four-week-old male SD rats were randomly divided into control group and CRF group ( n=20/per group). Control group was intragastric administration with distilled water, and CRF group was given adenine suspension (150 mg·kg -1·d -1). All the young rats were sacrificed after continuous gavages for 6 weeks. The full length of tibia was compared between the two groups. The width of tibia proximal growth plates was measured by micro-CT scanning, and the width of the growth plate was also measured in histological sections. Chondrocytes isolated from growth plate in two groups were cultured in vitro to P3 generation. Immunohistochemical staining was used to detect the expression of collagen Ⅱ, matrix metalloproteinase 13 (MMP-13) and β-catenin in chondrocytes. Western blotting was used to detect the protein expressions of collagen Ⅱ, MMP-13 and β-catenin. Results:Compared with the control group, the tibial length of rats in the CRF group was shorter [(27.32±5.81) mm vs (35.43±3.61) mm, t=5.226, P<0.001], the width of growth plate in micro-CT picture was more narrow [(0.72±0.22) mm vs (1.13±0.27) mm, t=5.096, P<0.001], and the relative width of the growth plate was also more narrow ( t=6.744, P<0.001) in histological sections. The results of immunohistochemistry and Western blotting showed the expressions of collagen Ⅱ in the CRF group decreased significantly ( t=8.212, P<0.001), MMP-13 ( t=13.091, P<0.001) and β-catenin ( t=7.534, P<0.001) increased significantly compared the control group in chondrocytes. Conclusion:The Wnt/β-catenin signaling pathway is highly expressed in the tibial growth plate of young rats with chronic renal failure, which leads to accelerated degeneration and differentiation of chondrocytes and a closure tendency of growth plate.

Objective:To investigate the role and mechanism of Nod-like receptor protein 3 (NLRP3) in chronic kidney disease (CKD)-related neointimal hyperplasia (NH) of vessels.Methods:Wild type C57BL/6J male mice were randomly divided into normal control group ( n=6) and experimental group ( n=18), by removal of 5/6 kidney and ligation of left common carotid artery to establish a NH model. After established successfully, the mice in NH experimental group were randomly divided into NH model group, NLRP3 inhibitor group, and drug control group ( n=6/group). C57BL/6J male mice with NLRP3 gene knockout group did not do any treatment after the establishment of NH model. After 3 weeks of feeding, the blood and vascular tissue samples of mice were collected. The pathological changes of vascular tissue samples in mice were observed by hematoxylin-eosin staining. The expressions and localization of NLRP3-related protein were observed by immunofluorescence staining. The expression of NLRP3 mRNA in vascular tissue was detected by quantitative real-time PCR. The activity of caspase-1 in vascular tissue was measured by colorimetric method. Human aortic smooth muscle cells (HASMCs) were treated with 10% uremic serum to simulate the body's internal environment during the uremic phase. NLRP3 small interfering RNA (siRNA) was transfected or NLRP3 inhibitor glibenclamide was added to the cell cultures. The expression of NLRP3 mRNA in HASMCs was detected by quantitative real-time PCR. The activity of caspase-1 in HASMCs was detected by colorimetric method. Results:Compared with the control group, the levels of serum creatinine and blood urea nitrogen were significantly increased in the NH model group (both P<0.01). The vascular histopathology showed that vascular intima thickened, vascular smooth muscle cells proliferated and hypertrophied, nuclei were deeply stained, and cells arranged disorderly and migrated to vascular intima in the experimental group. Quantitative analysis showed that the ratio of neointima to lumen increased significantly in the NH model group than that in control group ( P<0.01). Compared with the control group, the immunofluorescence staining of vascular tissue showed that the expressions of NLRP3, caspase-1, IL-18, IL-1β and proliferating cell nuclear antigen (PCNA) protein in the NH model group increased (all P<0.01), while the expression of α-SMA decreased ( P<0.01). NLRP3 was mainly located in vascular smooth muscle cells (VSMCs). VSMCs showed a synthetic phenotype. Compared with the NH model group, the expression of NLRP3, caspase-1, IL-18, IL-1β and PCNA protein in the NLRP3 inhibitor group and NLRP3 gene knockout group decreased (all P<0.01), the expression of α-SMA increased ( P<0.01), and the pathological changes of blood vessels alleviated. Compared with healthy serum group, the expression of NLRP3, IL-18, and IL-1β and bromodeoxyuridine (BrdU) uptake in uremic serum-stimulated group were increased (all P<0.01). After transfection of NLRP3 siRNA and addition of glibenclamide, the expression of NLRP3, IL-18, and IL-1β in VSMCs in uremic serum-stimulated group decreased, and BrdU intake decreased (all P<0.01). Conclusions:NLRP3 inflammatory bodies play an important role in promoting CKD-related neointimal hyperplasia of vessels, and glibenclamide can effectively reduce neointimal hyperplasia.

For patients at nutritional risk who need nutritional treatment, enteral nutrition should be preferred if there is no contraindication. Enteral nutrition is widely used in acute and critical diseases, inflammatory bowel diseases, perioperative management of gastrointestinal surgeries, and non-mild acute pancreatitis. The basic and clinical research on the mechanism of enteral nutrition therapy has become a hot topic in recent years. The majority believe that enteral nutrition therapy works through regulating mucosal immunity and intestinal microecological balance, but the underlying mechanism is still unclear. This review is focused on the mechanism of action of enteral nutrition, in order to inform future application in disease management and the selection of enteral nutrition formulations.