In this study,DNA molecular identification technology and chemical fingerprint method were adopted to evaluate the quality system of precise powder decoction pieces (PPDP) of S.suberectus dunn (SSD).ITS2 sequence was taken as DNA barcode to indentify SSD.Different specifications of PPDP were prepared,their dry extract contents were quantified in contrast with that of original slices.Three batches of SSD original slices were gleaned and the content uniformity,fingerprint and similarity evaluation before and after the mixing and pulverization were valued by HPLC-DAD.As a result,ITS2 successfully and accurately identified the SSD in this study.The extract rate of PPDP was 15.5％,1.11 times as much as the original slices.RSD of inter-assay dissolution of cepicatechin from the original slices was 11.0％,which was reduced to 1.0％ after mixing and preparing into PPDP.The relative peak area of the 14 common peaks identified by fingerpringts were larger,while the RSD values significantly decreased.It was concluded that the PPDP of SSD improved the extraction efficiency and uniformity of the original slices,featuring quite prospective in more reasonable and scientific clinical use.

Objective To investigate the place reaction of support drainage tube in cholecystojejunostomy and its pathological changes.Methods Eight pigs were randomized into 2 groups.The tube-placing cholecystojeunostomy(n=2)or choledochocholedochostomy(n=2)and non-tube-placing cholecystojejunostomy(n=2)or choledochocholedochostomy(n=2)were performed respectively.All the 8 pigs were sarcrificed 3 months after the operation for pathological examination.Results Gross anatomy catheter group showed anastomotic inflammatory hyperplasia, wall hardening hyperplasia,luminal narrow contracture and stone formation.Microscopic biopsy showed bile duct mucosa in interstitial lymphocytes, plasma cells and other chronic inflammatory cell infiltration, a large number of fibrous tissue hyperplasia.However, these features were not found in pigs without placing the tube.Conclusion The tube can not prevent the stenosis.It might promote the formation of stricture since it can stimulate inflammatory hyperplasia and tissue hardening.

Background:Reduction of incidence and recurrence rates of colorectal adenoma (CRA)are the keys for reducing the incidence of colorectal cancer. Studies have shown that insulin resistance is involved in this process. Aims:To investigate the correlation of insulin resistance with incidence and recurrence of CRA. Methods:Clinical data of 238 CRA patients were collected,and 200 patients with normal colonoscopy results were served as controls. Waist to hip ratio (WHR), fasting blood glucose (FPG),total cholesterol (TC),triglyceride (TG),high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C),adiponectin,fasting insulin (FINS),HOMA-IR were compared between the two groups. Correlation of insulin resistance with incidence and recurrence of CRA was analyzed. Results:WHR,FPG, TG,FINS,adiponectin and HOMA-IR were statistically different between CRA group and controls (P＜0.05),however, no significant differences in BMI,DBP,TC,HDL-C,LDL-C were found between the two groups. Incidence rate of CRA (80.1% vs. 41.4%)and recurrence rate of CRA (62.4% vs. 46.3%)were significantly increased in patients with insulin resistance than those in patients without insulin resistance. Logistic regression analysis showed that family history, metabolic syndrome and HOMA-IR were independent risk factors for incidence of CRA (P ＜0. 05 ),and metabolic syndrome,family history of adenoma,adenoma number,adenoma size,pathological type and HOMA-IR were independent risk factors for recurrence of CRA (P＜0.05). Conclusions:The incidence and recurrence rates of CRA are higher in patients with insulin resistance than those without insulin resistance.

Objective:To investigate the predictive value of mucosal vascular pattern (MVP) under narrow-band imaging (NBI) enteroscopy in patients with ulcerative colitis (UC) in clinical remission for histological healing and clinical recurrence.Methods:A total of 142 patients with UC in clinical remission who visited the First Affiliated Hospital of Weifang Medical University from January 2018 to January 2021 were included in the study and underwent colonoscopy. The white light and NBI endoscopic images were collected and biopsies were obtained. The Mayo endoscopic score (MES) was calculated based on white light images, and MVP staging was evaluated based on mucosal vascular patterns under NBI. Nancy index (NI) was used to evaluate histological healing and patients were followed up for 1 year. The Spearman correlation coefficients of MES and MVP with histological healing and recurrence were calculated. The receiver operator characteristic (ROC) curve was plotted and the area under curve (AUC) was applied to evaluate the accuracy of white light and NBI endoscopy for predicting histological healing of UC in clinical remission.Results:According to the MVP criteria, 47 were defined as clear, 63 blurred, and 32 invisible. Spearman correlation analysis showed a significant correlation between MVP under NBI and histological healing ( r=0.549, P<0.001) and a moderate correlation between MES under white light and histological healing ( r=0.462, P<0.001). Spearman correlation analysis showed a moderate correlation between MVP under NBI and clinical recurrence ( r=0.451, P<0.001) and a moderate correlation between MES under white light and clinical recurrence ( r=0.352, P<0.001). AUC of NBI for diagnosing histological healing of UC in clinical remission was 0.809 (95% CI: 0.738-0.879), with a sensitivity of 84.6% (77/91) and specificity of 64.7% (33/51), superior to the white light endoscopy, of which AUC, sensitivity and specificity were 0.763 (95% CI: 0.678-0.848), 81.3% (74/91) and 66.7% (34/51). Conclusion:MVP staging under NBI could predict histological healing of UC patients in clinical remission and is superior to white light endoscopy.

Objective:To compare the clinical efficacy of arthroscopic debridement, transtendon repair and tear completion and repair in treating Ellman II partial articular surface tendon avulsions.Methods:A retrospective case control study was conducted on 45 patients with partial articular surface tendon avulsions admitted to East Division of Shanghai Sixth Hospital Affiliated to Shanghai Jiao Tong University from December 2017 through December 2019. There were 18 males and 27 females, with a mean age of (56.4±5.0)years (range, 38-66 years). The patients were assigned to arthroscopic debridement group ( n=15), arthroscopic transtendon repair group ( n=15), and arthroscopic tear completion and repair group ( n=15). Operation time and complications were recorded. American Shoulder and Elbow Surgeons (ASES) score and University of California, Los Angeles (UCLA) score were measured preoperatively, at postoperative 3 months and at the latest follow-up. Results:All the patients were followed up for 8-32 months [(18.2±6.3)months]. In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the operation time was (43.7±3.1)minutes, (89.1±5.4)minutes, (62.2±3.6)minutes, respectively ( P<0.05). No complications such as nerve injury, infection and arthrofibrosis were observed after operation. In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the ASES score was preoperative (48.7±2.9)points, (49.1±3.0)points, (48.3±3.6)points, respectively ( P>0.05); the UCLA score was preoperative (15.5±1.3)points, (15.4±1.8)points, (15.2±1.4)points, respectively ( P>0.05). In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the ASES score at the latest follow-up was (90.1±1.6)points, (89.3±1.0)points, (89.4±1.0)points, respectively ( P>0.05); the UCLA score at the latest follow-up was (30.3±2.1)points, (29.0±2.3)points, (28.9±2.7)points, respectively( P>0.05). In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the ASES score at postoperative 3 months was (84.4±2.3)points, (73.5±3.6)points, (73.6±3.2)points, respectively; the UCLA score at postoperative 3 months was (26.9±1.4)points, (21.4±1.0)points, (21.1±1.0)points, respectively. In comparison, no significant difference was found between arthroscopic transtendon group and arthroscopic tear completion and repair group ( P>0.05). However, ASES score and UCLA score in arthroscopic debridement group were significantly higher than those in arthroscopic transtendon group and arthroscopic tear completion and repair group ( P<0.05). Conclusions:Arthroscopic debridement, transtendon repair and tear completion and repair are effective techniques for treatment of Ellman II partial articular surface tendon avulsions. However, the operation time and early efficacy of arthroscopic debridement are better than other two techniques.

Objective: To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP), especially for refractory RP. Methods: Clinical data of 22 RP patients were retrospectively analyzed. The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman′s classification (B). The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment). Results: All 22 patients were successfully treated. Among them, 18 patients (82%) had no bleeding. According to the classification of A, 15 patients (68%) had mild proctitis and 7(32%) experienced severe proctitis. Based on B classification, 9 patients (41%) were categorized as mild proctitis and 13(59%) as severe proctitis. Using the classification of A, the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score)(Spearman’s r=0.86, P<0.001). Conclusions Preliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP, but also maintains long-term efficacy for refractory RP. Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.

The many-banded krait, Bungarus multicinctus, has been recorded as the animal resource of JinQianBaiHuaShe in the Chinese Pharmacopoeia. Characterization of its venoms classified chief phyla of modern animal neurotoxins. However, the evolutionary origin and diversification of its neurotoxins as well as biosynthesis of its active compounds remain largely unknown due to the lack of its high-quality genome. Here, we present the 1.58 Gbp genome of B. multicinctus assembled into 18 chromosomes with contig/scaffold N50 of 7.53 Mbp/149.8 Mbp. Major bungarotoxin-coding genes were clustered within genome by family and found to be associated with ancient local duplications. The truncation of glycosylphosphatidylinositol anchor in the 3'-terminal of a LY6E paralog released modern three-finger toxins (3FTxs) from membrane tethering before the Colubroidea divergence. Subsequent expansion and mutations diversified and recruited these 3FTxs. After the cobra/krait divergence, the modern unit-B of β-bungarotoxin emerged with an extra cysteine residue. A subsequent point substitution in unit-A enabled the β-bungarotoxin covalent linkage. The B. multicinctus gene expression, chromatin topological organization, and histone modification characteristics were featured by transcriptome, proteome, chromatin conformation capture sequencing, and ChIP-seq. The results highlighted that venom production was under a sophisticated regulation. Our findings provide new insights into snake neurotoxin research, meanwhile will facilitate antivenom development, toxin-driven drug discovery and the quality control of JinQianBaiHuaShe.