Purpose To explore the ultrasound imaging characteristics and clinical significance of abnormal sylvian fissure in fetuses of transthalamic section at 22-26 weeks of gestation.Materials and Methods The ultrasound image characteristics,intracranial and extracranial malformations and clinical outcomes of 12 abnormal sylvian fissure cases of transthalamic section at 22-26 weeks of gestation in the Second Affiliated Hospital of Anhui Medical University from December 2018 to March 2022 were retrospectively analyzed.Results According to the ultrasound image characteristics of abnormal sylvian fissure,it could be divided into straight(4 cases)and shallow shapes(8 cases).The sylvian fissure of straight shapes was flat.Straight shapes were with 1 malformation of cortical development.The sylvian fissure of shallow shapes was corniform with unconspicuous insular platform.All of the shallow shapes were malformation of cortical development.Common intracranial abnormal signs mainly included other abnormal cerebral gyrus and sulcus(9 cases),ventricular dilatation or hydrocephalus(7 cases),partial or complete agenesis of corpus callosum(7 cases),etc.11 pregnant women chose to terminate their pregnancy,and 1 fetus died in the uterus after 5 days of ultrasound examination.Conclusion Fetal abnormal sylvian fissure at 22-26 weeks of gestation is an important clue to craniocerebral malformations,especially to malformation of cortical development.

Objective To systematically retrieve and integrate the clinical randomized controlled trials(RCTs)and systematic reviews/Meta-analyses of traditional Chinese medicine in the treatment of diabetic peripheral neuropathy(DPN)in recent 10 years,aiming to summarize the overall evidence distribution of traditional Chinese medicine in the treatment of DPN.Methods CNKI,WANFANG,VIP,CBM,PubMed,Web of Science,Embase and the Cochrane Library were used as retrieval database.The retrieval time was from January 1,2012 to October 23,2022.RCTs and systematic reviews/Meta-analyses were included.The distribution of evidence was displayed in the form of charts.AMSTAR-1 was used for the methodological quality evaluation of systematic reviews/Meta-analyses.Results A total of 1648 RCTs and 59 systematic reviews/Meta-analyses were included.The overall number of RCTs were on the rise,but most of the scale of the RCTs were relatively small,with 68％of the samples size of a single study concentrated between 50-100;The Duration of intervention was 4-8 weeks;Multi-therapy was the most commonly used intervention,among which the most involved intervention was the combination of TCM decoction;Traditional Chinese medicine monotherapy was mainly oral traditional Chinese medicine decoction.The evaluation indexes of clinical efficacy paid much attention to the total effective rate,nerve conduction velocity,TCM diseases and syndromes;economic index,quality of life,long-term efficacy and other indicators had attracted less attention of researchers.The overall methodological quality of systematic reviews/Meta-analyses was not high,most of which show good clinical efficacy,but lack sufficient evidence support.Conclusion The research results show that the treatment of diabetes peripheral neuropathy with TCM have good characteristics and advantages,the shortcomings are mainly reflected in the low quality of the overall methodology of systematic reviews/Meta-analyses.Suggesting that more high-quality clinical RCTs with breadth and depth are still needed in the future to verify the characteristics and advantages of traditional Chinese medicine in the treatment of diabetic peripheral neuropathy and provide data information support for evidence-based medicine.

Objective : To investigate the protective effect and mechanism of Hudi Enteric capsules in ionizing radiation injury to small intestinal crypt cells (IEC⁃6 cells) in rats. Methods : IEC⁃6 cells were irradiated with 6 mega electron volt X ⁃rays (2 , 4 , 6 , 8 and 10 Gy) , cell clone formation assay was used to detect cell proliferation , and the 6 Gy ionizing radiation was selected to establish a cellular radiation damage model according to the cell survival rate. The effect of each concentration ( 12. 5 , 25 , 50 , 100 and 200 μg/ml) of Hudi enteric extract on the viability of IEC⁃6 cells was examined by cell counting kit⁃8(CCK⁃8) method , and the effect on the viability of IEC⁃6 cells after irradiation at ( 10 , 20 , 40 and 80 μg/ml) concentrations was examined according to the results. After obtaining the optimal irradiation dose and extract concentration , the cells were divided into control group , model group and Hudi extract group (80 μg/ml) , the control group was pseudo⁃irradiated and the other two groups received 6 Gy of ionizing radiation , and the Hudi enteric extract group was pre⁃treated with drugs 2 h before irradiation. Apoptosis was detected by Annexin V ⁃PI double staining; cell senescence was detected by β ⁃galactosidase (β⁃Gal) staining; reactive oxygen species was detected by DCFH⁃DA fluorescent probe ; the corresponding protein expression of p16 , p21 , Catalase (CAT) and Superoxide dismutase ( SOD2) was detected by Western blot. Results : The proliferation of IEC⁃6 cells was inhibited by radiation doses ranging from 4 Gy to 10 Gy(P < 0. 001) ; (P < 0. 001) , and the apoptosis rate , β ⁃Gal positivity rate and DCFH⁃DA fluorescence intensity in the Hudi enteric extract group were lower than those in the model group (P < 0. 05) . The protein expressions of CAT and SOD2 in the Hudi extract group were higher than those in the model group ( P < 0. 05) , and the protein expressions of p16 and p21 were lower than those in the model group (P < 0. 05) . Conclusion The mechanism of action of Hudi enteric capsules that attenuate radiation damage in IEC⁃6 cells may be related to the inhibition of reactive oxygen species production , reduction of oxidative stress , and attenuation of cellular senescence and apoptosis.

Objective    To investigate the effect of optimized arterial perfusion strategy on total arch replacement for acute type A aortic dissection (AAAD) with malperfusion syndrome (MPS). Methods    From 2017 to 2019, 51 patients with AAAD and MPS who had received total arch replacement with optimized arterial perfusion strategy in our hospital were included in the optimized perfusion group, including 40 males and 11 females, with an average age of 47.43±13.39 years. A total of 40 patients with AAAD and MPS who had been treated with traditional Sun's surgery were taken as the traditional control group, including 31 males and 9 females, with an average age of 50.66±12.05 years. The perioperative clinical data of the two groups were compared. Results    The preoperative baseline data of the two groups were basically consistent (P>0.05). The comparison of operative data between the optimized perfusion group and the traditional control group showed that in the optimized perfusion group, the extracorporeal circulation time, aortic occlusion time, and circulation-out cerebral perfusion time were significantly less than those in the traditional control group (223.64±65.13 min  vs. 266.77±87.04 min, 114.48±27.28 min vs. 138.20±39.89 min, 8.28±3.81 min vs. 50.53±23.60 min, all P≤0.05). The lowest intraoperative nasopharyngeal temperature in the optimized perfusion group was significantly higher than that in the traditional control group (27.10±1.18℃ vs. 23.6±3.30℃, P=0.000). Postoperative wakefulness time of the optimized perfusion group was earlier than that of the traditional control group (4.50±1.35 h vs. 5.27±1.15 h, P=0.019). The volume of blood transfusions in the optimized perfusion group was significantly less than that in the traditional control group (13.25±9.06 U vs. 16.95±7.53 U, P=0.046). There was no significant difference in ICU time and invasive ventilation time between the two groups (P>0.05). Postoperative complications of the two groups showed that the incidence of postoperative continuous renal replacement therapy in the optimized perfusion group was significantly lower than that in the traditional control group, with a statistically significant difference (21.6% vs. 42.5% P=0.003). The incidence of postoperative delirium, coma, low cardiac row syndrome and limb ischemia in the optimized perfusion group was lower than that in the traditional control group, but the difference was not statistically significant (P>0.05). The incidence of postoperative hemiplegia, sepsis, and secondary thoracotomy in the optimized perfusion group was higher than that in the traditional control group, and the difference was not statistically significant (P>0.05). Postoperative mortality in the optimized perfusion group was significantly lower than that in the traditional control group (13.7% vs. 27.5%), but the difference was not statistically significant (P=0.102). Conclusion    Optimized arterial perfusion strategy and its related comprehensive surgical technique reduce surgical trauma, shorten the operation time, reduce perioperative consumption of blood products. Postoperative wakefulness is rapid and the incidence of complications of nervous system, kidney and limb ischemia is low. Optimized arterial perfusion strategy is suitable for operation of AAAD with MPS by inhibiting the related potential death risk factors to reduce operation mortality.

ObjectiveTo investigate the efficacy and safety of sertraline combined with low-dose aripiprazole in the treatment of obsessive-compulsive disorder in children and adolescents. MethodsA total of 62 cases pediatric patients aged 9~16 years who attended the outpatient clinic of a psychiatric hospital in Xiamen from June 2018 to May 2020 and met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for obsessive-compulsive disorder were enrolled in the study. The selected children were randomly classified into two groups for different treatments. Control group （n=30） received sertraline monotherapy， and study group （n=32） received sertraline combined with low-dose aripiprazole treatment. At the baseline and the end of the 2^nd， 4^th， 8^th and 12^th weeks of treatment， children were assessed using Children's Yale-Brown Obsessive Compulsive Scale （CY-BOCS） and Treatment Emergent Symptoms Scale （TESS）. Thereafter， the clinical efficacy and adverse reactions were compared between two groups. ResultsThe compulsive behavior dimensional score of CY-BOCS of study group was lower than that of control group at end of the 2^nd and 4^th weeks of treatment （t=-2.083， -2.176， P<0.05）. At the end of the 2^nd week of treatment， the effective rate was 40.63% in study group， which was significantly higher than 3.33% in control group （χ²=12.317， P<0.01）. By the end of the 12^th weeks of treatment， the incidence rate of side effects yielded no statistical difference between two groups （χ²=1.608， P=0.205）. ConclusionCompared with sertraline monotherapy， its combination with low-dose aripiprazole treatment can effectively accelerate the improvement of clinical symptoms in childrenand adolescents with obsessive-compulsive disorder， while the combination therapy and sertraline monotherapy have equivalent safety.

Curcumin is the main active component of Curcuma longa,which has a variety of biological activities and pharmacological properties.Clinical studies have shown that curcumin and its derivatives can improve the pathological progress of osteoarthritis. The mechanism mainly includes enhancing the activity of antioxidant enzymes,inhibiting oxidative stress,and protecting cartilage from damage;blocking inflammation-related signal pathways,reducing the production and activity of inflammatory factors,and reducing inflammation;playing the role of immune regulation by interacting with immune cells and immune molecules;slowing down osteoarthritis by inhibiting chondrocyte apoptosis and enhancing cartilage protection. Curcumin is one of the potential drugs for the treatment of osteoarthritis.

Curcumin is the main active component of Curcuma longa,which has a variety of biological activities and pharmacological properties.Clinical studies have shown that curcumin and its derivatives can improve the pathological progress of osteoarthritis. The mechanism mainly includes enhancing the activity of antioxidant enzymes,inhibiting oxidative stress,and protecting cartilage from damage;blocking inflammation-related signal pathways,reducing the production and activity of inflammatory factors,and reducing inflammation;playing the role of immune regulation by interacting with immune cells and immune molecules;slowing down osteoarthritis by inhibiting chondrocyte apoptosis and enhancing cartilage protection. Curcumin is one of the potential drugs for the treatment of osteoarthritis.

Objective To study the pulmonary valve replacement(PVR) operation indications and timing,the choice of prosthetic valve,and the anticoagulation methods.Methods Between June 2006 and April 2017,10 patients(median age 22.5 years,range 10 to 46) underwent PVR at our hospital.These issues above were discussed by analysing data from the patients and literature review.Results The 10 patients were all diagnosed with congenital heart disease(CHD),6 with CHD and infective endocarditis and 4 with postoperation of complex CHD like tetralogy of Fallot or pulmonary artery atresia.Five patients had prior cardiac operations.Bioprosthesis valve was implanted in 2 cases,while mechanical valve in 8.The international normalized ratio(INR) was maintained between 1.8 and 2.5 for patients with mechanical valve.There was one in-hospital death,and the other 9 patients were all followed up.The median follow-up was 65 months(range,3-110 months).During follow-up,there was no death,and reoperation was undertaken in one patient who had ceased anticoagulation for 2 years with a mechanical valve,and bioprosthesis valve was chosed in reoperation,Except of this patient,no valve thrombus or severe bleeding complication happened.All prosthetic valves demonstrated normal function by cardiac color ultrasound.The mean peak transvalvular pressure gradient for the mechanical valves was 12.0 mmHg(range,8.7-14.0 mmHg),while for the bioprosthesis valves was 24.7 mmHg(1 mmHg =0.133 kPa) (range,22-27 mmHg) (P ＜ 0.01).Overall actuarial survival at 7 years for patients receiving bioprosthesis valve PVR was 100％,while for mechanical valve was 85 ％ (P =0.617);Overall actuarial freedom from reoperation at 7 years for patients receiving bioprosthesis valve PVR was 100％,while for mechanical valve was 71％ (P =0.414).The findings of literature review were as follows:the risk of valve thrombus or severe bleeding complication for mechanical pulmonary valve was not higher than bioprosthesis pulmonary valve under standard anticoagulant therapy;the durability of bioprosthesis pulmonary valves was unsatisfactory,while the medium and long term effects of mechanical valves were good;the hemodynamic properties of mechanical pulmonary valve were better than bioprosthesis pulmonary valve;the lowintensity anticoagulation method was safe and effective for Chinese people.Conclusion PVR is a safe and effective treatment for patients with severe pulmonary valve regurgitation or stenosis,and the medium and long term effects of mechanical valve are satisfactory.PVR is recommended as early as meeting the operation indications.The choice of a prosthetic valve should be careful and individual.At present,the bioprosthesis valves are implanted in pulmonery valve position more than mechanical valves.However,in select patients and by standard anticoagulant therapy,mechanical pulmonry valves will bring better benefit.The low-intensity anticoagulation method(INR 1.8-2.5) is safe and effective,and recommened for Chinese people.

Objective: To observe the effect of edaravone combining ulinastatin on brain protection in patients of type A aortic dissection (AAD) after total arch replacement. Methods: A total of 60 AAD patients with total arch replacement in our hospital from 2014-09 to 2016-01 were prospectively studied. Based on peri-operative application of edaravone and ulinastatin, the patients were divided into 2 groups: EU group: 1) the patients received ulinastatin 300000 U/8h and edaravone 0.5mg/Kg/12h from administration to 3 days post-operation, 2) during cardiopulmonary bypass, the patients received ulinastatin 300000 U/2h and edaravone 0.5mg/Kg; Control group, the patients had no such treatment.n=30 in each group. The following items were observed:①operative condition;②blood levels of speciifc brain injury markers as S-100 and neuron speciifc enolase (NSE) at different time points: beginning of surgery (T0), opening aorta clamp (T1), right after cardiopulmonary bypass (T2), entering ICU (T3), 24h post-operation (T4) and 3 days post-operation (T5); ③post-operative condition. Results:①Durations of operation, cardiopulmonary bypass, cardiac arrest and bilateral antegrade selective cerebral perfusion (BACP), the frequency of BACP and UACP (unilateral antegrade selective cerebral perfusion), the lowest rectal temperature and blood levels of S-100, NSE at T0 were similar between 2 groups.②Compared with Control group, EU group had decreased S-100 and NSE from T1 to T5,P<0.05.③The in-hospital and ventilation time, frequency of PND and TND, the patients with CSS score≥16 before discharge and the in-hospital death rate were similar between 2 groups,P>0.05. Conclusion: Edaravone combining ulinastatin had brain protective effect in AAD patients after total arch replacement;it may reduce blood speciifc brain injury markers while the clinical signiifcance should be further investigated.

Objective To evaluate medium-term valvular functionality after transcatheter pulmonary valve replacement in sheep using a novel polymeric prosthetic pulmonary valve(PPHV). Methods In this study, we designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent, and the valve leaflet was made of 0. 1mm expanded polytetrafluoroethylene( ePTFE) . We chose bovine pericardium valve as control. Pulmonary valve stents were implanted in situ by right ventricular apical approach in 12 healthy sheep(10 for polymeric valve and 2 for bovine pericardium valve) weighing anaverageof(22.1±2.3)kg. Echocardiography,angiography,64-rowcomputedtomography(CT),andautopsywereusedto assess valvular function 12 weeks after implantation. Results Two PPHVs failed to be implanted in situ of pulmonary valve po-sition. Implantation was successful in the other 10 sheep. One sheep died of pneumonia, and the other 9 sheep survived at the end of follow-up. Echocardiography 12 weeks after implantation showed all the PPHVs exhibited good functionality and no sig-nificant insufficiency. The peak-peak transvalvular pressure gradient of the PPHVs was(28.2 ±8.0)mmHg(16-38 mmHg) (1 mmHg=0. 133 kPa), while that of two bovine pericardium valves were 16 and 21 mmHg. Angiography and CT 12 weeks after implantation demonstrated orthotopic position and normal operation of the valves,and no deformation of the valved stents. Pathological examination of the explanted PPHVs 12 weeks after implantation showed no degradation or damage of the ePTFE leaflets and most of the leaflets were thin and pliable, without significant thrombus or calcification, while visible pannus over-growth was found at the bottom of the valve leaflets, in the commissural areas and on the sealing cuff. Conclusion The medi-um-term effects of the novel ePTFE pulmonary valve after transcatheter pulmonary valve implantation in sheep is good. The no-vel PPHV exhibits good anti-adhesion, anti-degradation, anti-thrombus, anti-calcification performance and good biomechanical property. The hemodynamic parameter of PPHV is comparable to bovine pericardium valve. Optimizing the valve design might eliminate the problem about pannus overgrowth.