Rectal nonsteroidal anti-inflammatory drugs,glyceryl trinitrate,or combinations for prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis:A network meta-analysis

BACKGROUND Acute pancreatitis is the most common and severe complication of endoscopic retrograde cholangiopancreatography(ERCP).Recent evidence suggests that combinations based on rectal nonsteroidal anti-inflammatory drugs(NSAIDs)are more beneficial in preventing post-ERCP pancreatitis(PEP).Randomized controlled trials(RCTs)have also demonstrated the efficacy of glyceryl trinitrate(GTN).We conducted a network meta-analysis to compare NSAIDs and GTN for prevention of PEP and to determine whether they are better in combination.AIM To compare NSAIDs and GTN for prevention of PEP and to determine whether they are better in combination.METHODS A systematic search was done for full-text RCTs of PEP in PubMed,Embase,Science Citation Index,and the Cochrane Controlled Trials database.Inclusion and exclusion criteria were used to screen for eligible RCTs.The major data were extracted by two independent reviewers.The frequentist model was used to conduct this network meta-analysis and obtain the pairwise OR and 95%CI.The data were then extracted and assessed on the basis of the Reference Citation RESULTS Twenty-four eligible RCTs were selected,evaluating seven preventive strategies in 9416 patients.Rectal indomethacin 100 mg plus sublingual GTN(OR:0.21,95%CI:0.09–0.50),rectal diclofenac 100 mg(0.34,0.18–0.65),sublingual GTN(0.34,0.12–0.97),and rectal indomethacin 100 mg(0.49,0.33–0.73)were all more efficacious than placebo in preventing PEP.The combination of rectal indomethacin and sublingual GTN had the highest surface under the cumulative ranking curves(SUCRA)probability of(92.2%)and was the best preventive strategy for moderate-to-severe PEP with a SUCRA probability of(89.2%).CONCLUSION Combination of rectal indomethacin 100 mg with sublingual GTN offered better prevention of PEP than when used alone and could alleviate the severity of PEP.

Innovations in chronic anal fissure treatment:A systematic review

A chronic anal fissure is a common perianal condition.This review aims to evaluate both existing and new therapies in the treatment of chronic fissures.Pharmacological therapies such as glyceryl trinitrate(GTN),Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option,but with higher recurrence rates.Lateral sphincterotomy remains the gold standard for treatment.Anal dilatation has no role in treatment.New therapies include perineal support devices,Gonyautoxin injection,fissurectomy,fissurotomy,sphincterolysis,and flap procedures.Further research is required comparing these new therapies with existing established therapies.This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy.Perineal support may offer a new dimension in improving healing rates.Lateral sphincterotomy should be offered if pharmacological therapy fails.New therapies are not suitable as first line treatments,though they can be considered if conventional treatment fails.

STUDIES OF ASSESSMENT OF MYOCARDIAL VIABILITY BY TC-99M SESTAMIBI MYOCARDIAL SCINTIGRAPHY AND APPLICATION IN CORONARY REVASCULARIZATION

The purpose of the studies were to explore the effective ways to enhance theability of routine rest Tc-99m-sestamibi（MIBI）myocardial scintigraphy toassess myocardial viability and to evaluate value of eletrocardiographic（ECG）changes during the percutaneous transluminal coronary angioplasty（PTCA）In assessing viable myocardium,Four methods,（1）rest-nitroglycerinaugment,（2）rest-gated,and（4）meaaurement of ECG changes in ST-T,QRSelectric axis were used in 20,30,10 and 15 patients with coronary artery d.s-ease treated with coronary revascularization.The results showed that in eval-uating viable myocardium,the positive predictive values for methods（1）-（4）were 95.9%,68.5%.84.1% and 88.9%,respectively,the negative predic.tive values were 68.2%.90.1%,90.0% and 83.30%.respectively:the predic-tire accuracy rates were 82.5%,77.3%,87.2% and 86.7%,respectively,The results indicate that identification of viable myocardium with 99mTc-MIBI can be effectively enhanced with methods（1）-（3）;the method（4） isgood one to assess myocardial viability,the 99mTc-MIBI myocardial scintig-rephy can provide objective data for evaluating treatment effects by coromaryrevascularization.

Effects of Zhengtian Pills on Migraine Headache in Rats via Transient Receptor Potential Vanilloid 1

Objective To investigate the effects and molecular mechanism of Zhengtian Pills （ZTP） on migraine headache. Methods All rats were randomly divided into control, positive control, migraine model, low- and high-dose ZTP groups, and glyceryl trinitrate was injected to induce migraine headache. The time of ears turning red, frequency of scratching head, climbing the cage, and head-twitching were used to evaluate rat behaviors. After 10 d administration of ZTP, the expression levels of transient receptor potential vanilloid 1 （TRPV1） both in cortex and hippocampus were determined by Western blotting. Results After 2 min of glyceryl trinitrate injection, rats showed headache phenomena that parallels the clinical symptoms of migraine, which peaked in 30 min, and lasted for 60 min. Frequency of head-twitching and numbers of scratching head in glyceryl trinitrate （GTN） group were significantly increased. In contrast, after ZTP （1.08 g/kg, ig） treatment, the numbers of scratching head with fore-limb, hind-limb and the frequency of head-twitching were significantly decreased. Flunarizine （FLU） and low-dose ZTP （0.54 g/kg） also showed a trend to decrease the numbers of scratching head and head-twitching frequency, but no significant difference. Besides, ZTP significantly decreased the up-regulated TRPV1 protein expression level both in cortex and hippocampus. Conclusion The present study shows that ZTP could significantly improve the migraine symptoms of headache in rats and TRPV1 might be one of the important molecular mechanisms. This is the first report about the effect of ZTP on TRPVl protein expression level both in cortex and hippocampus of rats.

A Green and Efficient Trinitration System for Aromatic Compounds with Bi（NO3）3·5H2O/[HMIMICIO4 as Catalyst in HNO3/Ac2O

To investigate the green trinitration method of aromatic compounds, with Lewis acid/ionic liquid as catalyst and HNOJAc2O as nitration reagent, a Lewis acid/ionic liquid/HNO3/Ac2O system was established. In various combinations of Lewis acids and ionic liquids, Bi（NO3）3-5H2O/[HMIM]CIO4 proved to be a very efficient catalyst for the trinitration of activated aromatic compounds and reusable for 3 times. Reaction conditions for the trinitration were optimized and yields of the trinitro products were from mild to excellent. This sulfuric acid-free system has the advantages of strong trinitration ability, low environment pollution, low toxicity, low cost and high potential for industrial application.