Pyongyang Medical University

Background and Aim: Osteoporosis is an important type of metabolic bone disease in chronic cholangiogenic liver disease, with an incidence of up to maximum 72%. Osteoporosis and osteomalacia in patients with chronic liver disease are collectively referred to as "hepatic osteodystrophy," which is commonly found in patients with intestinal malabsorption and progressive primary biliary cirrhosis. To deal with the induction of osteoporosis by chronic cholestasis, we aimed to investigate the following: The aim of the study was to investigate the effect of iron intake on chronic cholestatic osteoporosis by surgical CBD partial ligation. Methods: Forty rats including weanling male rats weighing 70-80 g and adult male rats weighing 150-160 g were used. First, the rats were anesthetized with intraperitoneal ketamine injection, and then the CBD (Common Bile Duct) was exposed by surgical procedures, complete and partial ligation was performed, and then the abdomen was closed. Partial ligation was performed by ligating different thicknesses of the suture needles with the common bile duct and then removing the suture needle. In the case of using suture needle 5-0, 85-90% of the common bile duct is considered to be obstructed and 75-80% for 4-0. After ligation of the common bile duct, naturally proceeding rats were included as contrast group and rats receiving oral administration of 6 mg/ kg/day of folate iron were included as experimental group. After 8 weeks, liver function tests (ALT, AST, ZTT) and histopathological observation of the femur (H-E stained samples) were performed in the contrast and experimental groups, respectively. The significance test for viability and prevalence of osteoporosis following CBD ligation was performed by using the chi-square test, and the significance test for liver function test values was performed by using the t-test. Results: Experimental osteoporosis is induced at 8 weeks after surgical CBD partial ligation (85-90% occlusion). Conclusion: Iron intake significantly suppressed the development of osteoporosis by chronic cholestasis.

Purpose: Our purpose is to set up the new criteria for initiating NOEF(non-oral enteral feeding) safely in acute pancreatitis patients by analyzing several univariate indices and multivariate clinical scoring systems measured in the early days of NOEF. Methods: We involved moderately severe and severe acute pancreatitis patients who received NOEF treatment. We made a univariate and multivariate analysis of all the demographical, clinical, laboratory, radiological indices and clinical scores before NOEF, to find out the independent evaluation factors of paralytic ileus during NOEF. By analyzing ROC(receiver operating characteristics) curve, optimal cut-off points of selected independent risk factors were defined. We determined the ranges below the cut-off points as the safe ranges out of paralytic ileus during NOEF. Results: A total of 136 patients was involved in our study. By the univariate analysis, abdominal pain, respiratory rate, body temperature, rebound tender on physical examination, band neutrophil count, SIRS(systemic inflammatory response syndrome) score, PASS(pancreatitis activity scoring system), BISAP(bedside index of severity in acute pancreatitis), Balthazar score were associated with occurrence of paralytic ileus during NOEF(P<0.05). By the multivariate analysis, respiratory rate and PASS were selected as the independent risk factors of paralytic ileus during NOEF(P<0.05). Areas under ROC curves(AUROCs) of respiratory rate and PASS in predicting paralytic ileus were 0.873(0.777-0.970), 0.897(0.795-0.999), respectively. The optimal cut-off points of highest odds ratios(OR) and negative predictive values(NPV) in predicting paralytic ileus after NOEF were respiratory rate≧25bpm and PASS≧120, respectively. Conclusion: Safe range for NOEF during acute pancreatitis treatment is PASS<120 or respiratory rate<25bpm.

Osteoporosis is an important type of metabolic bone disease in chronic cholangiogenic liver disease, with an incidence of up to maximum 72%. Osteoporosis and osteomalacia in patients with chronic liver disease are collectively referred to as "hepatic osteodystrophy," which is commonly found in patients with intestinal malabsorption and progressive primary biliary cirrhosis. To deal with the induction of osteoporosis by chronic cholestasis, we aimed to investigate the following: The aim of the study was to investigate the effect of iron intake on chronic cholestatic osteoporosis by surgical CBD partial ligation. Forty rats including weanling male rats weighing 70-80g and adult male rats weighing 150-160g were used. First, the rats were anesthetized with intraperitoneal ketamine injection, and then the CBD (common bile duct) was exposed by surgical procedures, complete and partial ligation was performed, and then the abdomen was closed. Partial ligation was performed by ligating different thicknesses of the suture needles with the common bile duct and then removing the suture needle. In the case of using suture needle 5-0, 85-90% of the common bile duct is considered to be obstructed and 75-80% for 4-0. After ligation of the common bile duct, naturally proceeding rats were included as contrast group and rats receiving oral administration of 6 mg/kg/day of folate iron were included as experimental group. After 8 weeks, liver function tests (ALT, AST, ZTT) and histopathological observation of the femur (H-E stained samples) were performed in the contrast and experimental groups, respectively. The significance test for viability and prevalence of osteoporosis following CBD ligation was performed by using the chi-square test, and the significance test for liver function test values was performed by using the t-test. Experimental osteoporosis is induced at 8 weeks after surgical CBD partial ligation (85-90% occlusion). Iron intake significantly suppressed the development of osteoporosis by chronic cholestasis.

Background: Infection control rate of debridement, antibiotics, and implant retention (DAIR) remains controversial. We aim to identify the influence of preoperative negative pressure wound therapy (NPWT) with intermittent pulsatile irrigation (IPI) on the efficacy of DAIR in delayed periprosthetic joint infection (PJI) hip cases. Methods: 112 patients with delayed hip PJI were randomized into two groups. Group A included 53 cases treated with DAIR only whereas group B included 59 cases treated with NPWT and IPI followed by DAIR. Surgical invasiveness parameters, postoperative drainage, inflammation markers, and reinfection rate were evaluated in two groups. Results: In group B, serologic and clinical inflammation markers decreased significantly than in group A, and major systemic or local adverse events were not observed during preoperative NPWT-based therapy. The duration of debridement and surgical invasiveness indices such as hemoglobin decrease were significantly lower in group B. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were significantly lower in group B until 3 weeks after DAIR. In group B, the duration of antibiotics administration was considerably shorter than in group A. In groups A and B, reinfection rates were 35.8% and 1.7% at the final follow-up. Conclusions: Preoperative and postoperative NPWT could maximize DAIR's indication and success rate in delayed PJI cases.

Background and Aim: Flat warts caused by human papilloma virus type 3, 10, 27 and 41 brings many cosmetic problems to children and young adults. Cryotherapy is the destruction method of tissue by the application of extreme cold and has been indicated as a treatment modality for the management of flat warts. Acupuncture is widely used in the prevention and treatment of a variety of diseases. Precisely how acupuncture destroys warts is not well understood, but theory is that acupuncture at SI6 weakens the virus function by activating the immune system. To determine the efficacy of combined cryotherapy and acupuncture of flat warts. Methods: 83 patients (age range; 10~40 years) with clinically diagnosed flat warts (1 month after onset) were recruited. Patients were randomized to receive combination of cryotherapy and acupuncture, cryotherapy alone and acupuncture alone. Data was analyzed to determine local response and clinical effectiveness of combination treatment. Results: Of 83 patients, 34 (41.0%) were treated with combination treatment, 26 (31.3%) were treated with cryotherapy alone and 23 (27.7%) were treated with acupuncture alone. 31 patients (91.2%) in the combination group vs 9 patients (34.6%) in the cryotherapy group vs 4 patients (17.4%) had complete resolution of flat warts. Conclusion: Combination of cryotherapy and acupuncture was significantly more effective than individual treatments.

Background and Aim: Premature Ovarian Failure (POF), or premature menopause affects 1-3% of women. Patients experience menopausal symptoms, genital dystrophy, high FSH and LH levels and low estradiol. Hormone replacement therapy and other treatments can help, but their side effects are debated. To better understand POF and develop effective treatments, we used D-galactose-induced models to test various drugs. Methods: Female Wistar rats (160-180 g, 16-18 weeks) were used to study D-galactose-induced Premature Ovarian Failure (POF). Rats were injected with 0.5 mL of 5% D-galactose subcutaneously for 30 days. Post-treatment, endometrium and myometrium thickness, ovary weight and volume and follicle number were measured. The POF models were then treated with Styphnolobium japonicum fruit extract, Cimicifuga heracleifolia extracts, folliculin and rigevidon and the karyopyknotic index, uterine gland number and size, ovary weight and follicle count were assessed. Results: In the D-galactose-induced POF models, endometrium and myometrium thickness, ovary weight and volume and mature follicle number significantly decreased. Conclusion: The effectiveness of drugs in reversing these effects was ranked as follows: folliculin, Cimicifuga heracleifolia extract, rigevidon and Styphnolobium japonicum extract.

Background and Aim: Recently, the rapid development of science and technology has led to the development of capillary studies. Particularly, the observation of microcirculation in nail fold capillaries, called “ghost vessels”, has attracted much attention from doctors. Therefore, we studied the microcirculatory kinetics of the nail fold capillary in pregnant women and the relationship between blood flow rate and passive smoking. Methodology: We took-up a case-control study with 83 normal pregnant women, 24 passive smoking pregnant women and 12 healthy non-pregnant women who hospitalized in Pyongyang University Hospital of Medical Sciences from May 2020 to February 2022. We analyzed the morphological indices and blood flow rate of the nail fold capillary in pregnant women according to the weeks of gestation and passive smoking. Results: The blood flow rate of the nail fold capillary in normal pregnant women significantly increased and in passive smoking pregnant women according to the weeks of gestation significantly decreased. Conclusion: Microcirculation is altered in normal pregnant women and microcirculatory behavior is different in passive smoking pregnant women.

Background and Aim: Stroke is a life-threatening disease leading to long-term disability in stroke survivors. In most acute ischemic strokes, the underlying cause is a thrombotic or embolic vascular occlusion. Therefore, one strategy for treating stroke is to restore blood flow within the ischemic area with a thrombolytic agent. This study was designed to investigate the effect of Ligustrazine on ischemic stroke induced by photochemical reaction in rat. Methods: Ischemic stroke model in rats was induced by the thrombotic occlusion of MCA based on the photochemical reaction between rose Bengal and green light, which causes endothelial injury followed by platelet activation and thrombus formation at the site of the photochemical reaction. Ligustrazine were injected i.v. 15 min (10 mL/kg) before rose Bengal injection and 2 hr (10 mL/kg) after injection of the dye. Neurological deficit, occlusive time, platelet aggregation, thromboxane B 2 and bleeding time were measured by conventional methods. Results: Ligustrazine decreased the neurological deficit about 24 hr after injection of rose Bengal, prolonged the occlusive time in middle cerebral artery and inhibited ex vivo platelet aggregation at 4 hr after injection of dye. Conclusion: Our results suggest that Ligustrazine used in the present study has potential effect on ischemic stroke induced by photochemical reaction.

Background and Aim: The prebiotic potential of lactulose is well known, but its effect to inhibit enteric bacterial dynamics and gut permeability has not yet been investigated in experimental studies. The present study aims to assess the effects of lactulose on the enteric bacterial dynamics gut permeability in a model of bile duct ligation in Wistar rats. Methods: Wistar rats were assigned into 3 groups, the Sham-operated control, bile duct ligated (BDL) and BDL+ Lac group on the 28th day of bile duct ligation. Animals of BDL + Lac groups were treated with lactulose (1.0 g/kg), administrated by gavage, once a day for 7 days. Bacterial translocation into the organs and bacterial overgrowth as the indicators of the enteric bacterial dynamics and the levels of DAO and D-lactate as the biochemical makers of the gut permeability were measured in each group. Results: The bacterial colony forming units (CFU) in spleen and liver of BDL+Lac group was significantly decreased compared with BDL model group (P<0.01) and significant decrease of bacterial CFU was seen in the intestinal lavage in BDL+Lac group compared to BDL group (P<0.01). On the other hand, Lactulose revealed significant inhibitory effect as evidence by decreasing plasma DAO activity and D-lactate levels (P<0.01) in this model. Conclusion: These results indicate that lactulose can inhibit the enteric bacterial overgrowth, bacterial translocation (BT) and increasing gut permeability by opening the mucosa tight junction in ductal obstruction and obviate even systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) induced by obstructive jaundice.

Abstract Background:Di-(2-ethylhexyl) phthalate (DEHP) is one of the most widely used plasticizers.Many studies focus on the impact of continuous exposure to DEHP on humans and ecosystems.In this study, the bibliometric analysis of DEHP and its metabolites research was conducted to assess the research performances, hotspot issues, and trends in this field. Method:The data was retrieved from a web of science core collection online database.VOSviewer 1.6.18 was used to analyze. Result:A total of 4672 publications were retrieved from 1975 to 2022 October 21.The number of publications and citations increased annually in the last decades.China had the largest number of publications and the USA had the highest co-authorship score.The most productive and most frequently cited institutions were the Chinese Academy of Sciences and the Centers for Disease Control & Prevention(USA) , respectively.The journal with the most publications was Science of Total Environment and the most cited one was Environmental Health Perspectives.The most productive and cited author was Calafat AM(USA).The most cited reference was “Phthalates: Toxicology and exposure”.Four hotspot issues were as follows: influences of DEHP on the organisms and its possible mechanisms; assessment of DEHP exposure to the human and its metabolism; dynamics of DEHP in external environments; indoor exposure of DEHP and health outcomes.The research trends were DNOP, preterm birth, gut microbiota, microplastics, lycopene, hypertension, and thyroid hormones. Conclusion:This paper will be a useful resource for researchers to rapidly take the valuable information related to the authoritative scholars, publications, journals and institutions, hotspot issues, and trends in this research field.