Topical photodynamic therapy (PDT),a highly effective,safe and non-invasive therapeutic method,exerts good therapeutic effects on various diseases in dermatology,such as actinic keratosis,condyloma acuminatum,acne,and so on.The major drawback of PDT is pain during the treatment.Some patients have to interrupt or terminate the treatment because of pain intolerance.Some progress has been made in the management of PDT-related pain.It has been revealed that multiple factors are associated with PDT-related pain,including individual factors,lesion characteristics,therapeutic parameters (such as light sources,photosensitizers).Many methods can be used to manage PDT-related pain,including local cooling,oral analgesics,two-step irradiance protocol,topical anesthesia,injection anesthesia,inhalation anesthesia,transcutaneous electric nerve stimulation,hypnosis.

Objective Class 1 integrase(intI 1),qacE△1-sul1 and sul2 genes were detected in trimethoprim-sulfamethoxazole resistant Stenotrophomonas maltophilia by PCR to assess the relationship between the antibiotic resistance mechanism for trimethoprim-sulfamethoxazole (TMP-SMZ)and these genes distribution.Methods S.maltophilia isolates were collected from patients treated in Affilitated hospital of Nanjing University of TCM during January to May in 2013,DNA was ab-stracted by boiling method and genes were detected by polymerase chain reaction.Results intI 1 genes were observed posi-tive in 25 of 28 strains resistant for TMP-SMZ,qacE△1-sul1 genes were positive in 21 while sul2 genes positive in 15,the positive rates of intI 1,qacE△1-sul1 and sul2 genes were 89.29%,75% and 53.57%;in 18 trimethoprim-sulfamethoxazole sensitive strains,5 were intI 1 positive,4 were qacE△1-sul1 positive while sul2 were none,the positive rates of intI1 and qacE△1-sul1 were 27.78% and 22.22%.Conclusion Most of stenotrophomonas maltophilia resisted trimethoprim-sulfa-methoxazole had intI 1,qacEΔ1-sul 1 and sul2 genes.

Objective To assess the capability of monochromatic energy images of Gemstone spectral imaging(GSI) in reducing artifacts caused by metallic implants. Methods Twelve subjects with metallic implants underwent GSI (Discovery CT750 HD, GE Healthcare, Milwaukee ). The metallic orthopedic implants included 3 patients of dentures, 2 patients of cervical spinal vertebraplasty, one clavicle fracture fixation, one lumbar spinal vertehraplasty, 3 patients of artificial femoral head, one iliac fracture fixation and one tibial fracture fixation. GSI was performed by using a single source ultra-fast dual energy X-ray switching (80 kVp and 140 kVp). Following GSI scanning, thin slice images were reconstructed into 1.25 mm slice thickness. The monochromatic energy images were set to the same window width and level (window width 1500 HU,window level 500 HU). The artifact indexes (AI) at different kiloelectronvolts (keV) images were measured and compared. 3D reconstruction was performed using images with minimal AI. Result The artifacts index on monochromatic energy images varied with the change of keV. Of the images from 12 subjects, the maximal AI ranged between 145-225 at 40 keV, and minimal AI ranged between 15-90 at the 95-140 keV. The artifacts are clearly visible on polychromatic energy images and the artifacts are reduced markedly on the monochromatic energy images with minimal AI. Conclusion The artifacts caused by metallic implants can be reduced significantly by GSI with high keV monochromatic energy images.

The present study evaluated the effect of non-thermal plasma on skin wound healing in BalB/c mice. Two 6-mm wounds along the both sides of the spine were created on the back of each mouse (n=80) by using a punch biopsy. The mice were assigned randomly into two groups, with 40 animals in each group: a non-thermal plasma group in which the mice were treated with the non-thermal plasma; a control group in which the mice were left to heal naturally. Wound healing was evaluated on postoperative days (POD) 4, 7, 10 and 14 (n=5 per group in each POD) by percentage of wound closure. The mice was euthanized on POD 1, 4, 7, 10, 14, 21, 28 and 35 (n=1 in each POD). The wounds were removed, routinely fixed, paraffin-embedded, sectioned and HE-stained. A modified scoring system was used to evaluate the wounds. The results showed that acute inflammation peaked on POD 4 in non-thermal plasma group, earlier than in control group in which acute inflammation reached a peak on POD 7, and the acute inflammation scores were much lower in non-thermal group than in control group on POD 7 (P<0.05). The amount of granular tissue was greater on POD 4 and 7 in non-thermal group than in control group (P<0.05). The re-epithelialization score and the neovasularization score were increased significantly in non-thermal group when compared with control group on POD 7 and 10 (P<0.05 for all). The count of bacterial colonies was 10(3) CFU/mL on POD 4 and <20 CFU/mL on POD 7, significantly lower than that in control group (10(9) CFU/mL on POD 4 and >10(12) CFU/mL on the POD 7) (P<0.05). It was suggested that the non-thermal plasma facilitates the wound healing by suppressing bacterial colonization.

OBJECTIVE: To evaluate the efficacy and safety of thread-dragging through fistula method in treating patients with simple anorectal fistula. METHODS: In this multi-centered, prospective, and randomized controlled clinical trial, 244 patients with simple low or high anorectal fistula were randomly divided into study group (with the method of thread-dragging through fistula) and control group (with the method of incision or thread-drawing). The healing time and curative rate of anorectal fistula, and the integral calculus of clinical symptom and life quality evaluations before and after treatment were all examined. The maximal anal canal squeeze pressure was measured to compare the therapeutic safety between these two groups. The health economical benefits were also assessed to determine which therapeutic method was more economical. RESULTS: The curative rate of simple low and high anorectal fistula were of no significant differences between the study group and the control group. The healing time of simple low anorectal fistula in the study group and the control group were (22.26+/-8.67) d and (31.41+/-11.39) d respectively, while the healing time of simple high anorectal fistula in the study group and the control group were (24.73+/-8.15) d and (32.20+/-12.60) d respectively, and there revealed significant differences between these two groups. Each integral calculus of clinical symptom evaluation in the study group was not obviously different from those in the control group besides the integral calculus of anal sphincter function. The integral calculus of life quality between the study group and the control group of simple low anorectal fistula had no significant differences. The integral calculus of anal sphincter function and confidence in treatment in the study group of high anorectal fistula were better than those in the control group. The hospitalization expense of the study group was remarkably lower than that of the control group. The maximal anal canal squeeze pressure in the study group after treatment was not reduced obviously as compared with that in the same group before treatment, while it was decreased significantly in the control group after treatment as compared with those in the same group before treatment and in the study group after treatment. CONCLUSION: The method of thread-dragging through fistula in treating simple low and high anorectal fistula can shorten the course of the disease, save the hospitalization expenses, improve the life quality of the patients, and protect the anal sphincter function.

Hepatocellular carcinoma (HCC) is a malignant tumor with high incidence rate and mortality in the world. Surgical resection is the main radical method. However, the high recurrence rate leads to poor prognosis. Neoadjuvant therapy refers to anti-tumor therapy for resectable HCC before surgery to reduce tumor load and postoperative recurrence. Although more and more studies show that neoadjuvant therapy can bring survival benefits to patients with liver cancer. However, the indication, applicable population, treatment mode, treatment cycle and safety of new adjuvant therapy are still controversial. In this review, we will review the above issues, as well as the clinical application and research progress of neoadjuvant in hepatocellular carcinoma.

Objective To establish a reference interval for the pepsinogen(PG)Ⅰ,PGⅡ and PGⅠ/PGⅡ in healthy adult subjects in Zhejiang Province.Methods The data of 45 504 healthy adult subjects were collected,and the levels of serum PGⅠ and PG Ⅱ were detected by chemiluminescence microparticle immunoassay.The reference range of PGs were determined according to the CLSI-C28-A3 file.Results The median serum PGⅠ concentration in male was 132.62μg/L,PGⅡ concentration was 8.10μg/L,and PGⅠ/PGⅡ was 15.9.For females,they were 107.44μg/L,6.96μg/L and 15.0,respectively.PGI,PGⅡ concentration and PGⅠ/PGⅡ ratio were significantly higher in males than in females(P<0.001).The levels of PGⅠ and PGⅡ increased with age(P<0.001).Serum PGⅠ reference interval for male:59.79-234.97μg/L for 19-39 years old,63.33-294.62μg/L for 40-59 years old,64.25-333.61μg/L for≥60 years old,PGⅡ reference interval:3.33-22.60μg/L for 19-39 years of age,3.79-33.89μg/L for 40-59 years of age,4.15-42.08μg/L for≥60 years of age,PGⅠ/PGⅡ reference interval:those aged 19-39 years ranged from 7.3 to 31.4,those aged 40-59 years ranged from 5.8 to 30.9,and those aged≥60 years ranged from 3.9 to 30.7.The reference intervals of female PGⅠ were 48.79-215.68μg/L,52.10-276.01μg/L,and 64.34-317.20μg/L,respectively.The reference intervals of female PgⅡwere:2.87-23.93μg/L,3.41-33.31μg/L and 3.88-39.16μg/L,respectively.The reference intervals of of female PGⅠ/PGⅡ are 6.6-28.1,5.2-27.9 and 3.6-26.2.Conclusion This study determined the reference range of serum PGs deficiency in healthy subjects of different sex and age in Zhejiang Province.

The present study evaluated the effect of non-thermal plasma on skin wound healing in BalB/c mice.Two 6-mm wounds along the both sides of the spine were created on the back of each mouse (n=80) by using a punch biopsy.The mice were assigned randomly into two groups,with 40animals in each group:a non-thermal plasma group in which the mice were treated with the non-thermal plasma; a control group in which the mice were left to heal naturally.Wound healing was evaluated on postoperative days (POD) 4,7,10 and 14 (n=5 per group in each POD) by percentage of wound closure.The mice was euthanized on POD 1,4,7,10,14,21,28 and 35 (n=1 in each POD).The wounds were removed,routinely fixed,paraffin-embedded,sectioned and HE-stained.A modified scoring system was used to evaluate the wounds.The results showed that acute inflammation peaked on POD 4 in non-thermal plasma group,earlier than in control group in which acute inflammation reached a peak on POD 7,and the acute inflammation scores were much lower in non-thermal group than in control group on POD7 (P＜0.05).The amount of granular tissue was greater on POD 4 and 7 in non-thermal group than in control group (P＜0.05).The re-epithelialization score and the neovasularization score were increased significantly in non-thermal group when compared with control group on POD 7 and 10 (P＜0.05 for all).The count of bacterial colonies was 103 CFU/mL on POD 4 and ＜20 CFU/mL on POD 7,significantly lower than that in control group (109 CFU/mL on POD 4 and ＞1012 CFU/mL on the POD 7) (P＜0.05).It was suggested that the non-thermal plasma facilitates the wound healing by suppressing bacterial colonization.