ObjectiveTo discuss the clinical diagnosis and treatment of multiple endocrine neoplasia ( MEN ) 2A, and report the mutation of the RET proto-oncogene in a pedigree of three patients with MEN 2A.MethodsBilateral adrenalectomy was performed on two of the three patients with hypertension and bilateral adrenal-conserving adrenal pheochromocytoma resection was performed on the other patient. All three patients were treated by total thyroidectomy and neck lymphadenectomy. Twelve family members were recruited to the study. Peripheral blood was collected and total genomic DNA was prepared for polymerase chain reaction (PCR). PCR products of exon 10 and exon 11 of the RET proto-oncogene were purified and a direct DNA sequence analysis was performed.ResultsThe pathological diagnosis of the specimens was bilateral adrenal pheochromocytoma and medullary thyroid carcinoma in all the three patients. There was no tumor recurrence or distant metastasis after 1.5 - 5 years of follow-up. A missense mutation of TGC (Cys)to CGC (Arg) at codon 634 in exon 11 of the RET proto-oncogene was detected in all three patients. Genetic screening identified two mutation carriers in the other members of this pedigree.ConclusionGenetic mutation screening and surgical intervention may be helpful to the members of high-risk families.

Objective To systematically assess the effectiveness and safety of acupuncture and moxibustion for treatment of rheumatoid arthritis. Methods Articles were searched from databases, i.e., CNKI, VIP, WanFang Data, CBM, Embase, and PubMed. Articles about RCT on acupuncture and moxibustion for rheumatoid arthritis and traditional medicine therapy were under meta-analysis. Results Totally 24 articles involving 2006 patients were included. The results of meta-analysis indicated that the overall effective rate of treatment in the group receiving acupuncture and moxibustion was higher than that in the drug group, with statistical significance [OR=2.73, 95%CI (2.18, 3.41), Z=8.78, P<0.000 01]. Sub-group analysis showed that:acupuncture and moxibustion showed statistical significance in decreasing serum RF levels compared with drug therapy [MD=-2.92, 95%CI (-5.60, -0.25), P<0.05]. Acupuncture and moxibustion showed statistical significance in decreasing serum ESR levels compared with drug therapy [MD=-2.99, 95%CI (-4.78, -1.21), P<0.05]. Acupuncture and moxibustion showed statistical significance in decreasing serum CPR levels compared with drug therapy [MD=-1.44, 95%CI (-2.44, -0.44), P <0.05]. Conclusion The overall effective rates of acupuncture and moxibustion for rheumatoid arthritis and the decreasing levels of RF, ESR, CRP are superior to drug therapy, but it still needs larger samples, multi-center, and high quality RCT to verify.

OBJECTIVETo compare the clinical efficacy differences between Zheng's gold hook, fishing acupuncture and electroacupuncture (EA) for lumbar disc herniation (LDH).

METHODSSixty patients of LDH were randomly allocated to a gold hook fishing acupuncture group and an EA group, 30 cases in each one. Lumbar Jiaji (EX-1 B 2), Yaoyangguan (GV 3), Shenshu (BL 23), Dachangshu (BL 25), Guanyuanshu (BL 26) and ashi points were selected in the gold hook fishing acupuncture group; after the needles were inserted, the manipulation of gold hook fishing acupuncture was applied at tendon junction points and ashi points. The identical acupoints were selected in the EA group and patients were treated with EA. The treatment was both given once a day; ten days of treatment were taken as one session, and totally 3 sessions were given. The clinical effective rate, visual analogue scale (VAS), low back pain score and Oswestry disability index (ODI) were used for efficacy evaluation.

RESULTSThe effective rate was 93.3% (28/30) in the gold hook fishing acupuncture group, which was superior to 86.7% (26/30) in the EA group (P < 0.05). The VAS, low back pain score and ODI were both significantly improved after treatment (all P < 0.05), which were more significant in the gold hook fishing acupuncture group (all P < 0.05).

CONCLUSIONZHENG's gold hook fishing acupuncture could effectively improve the symptoms and sings of LDH, reduce the disability index and improve the quality of life, which is superior to EA.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Intervertebral Disc Displacement ; therapy ; Low Back Pain ; therapy ; Male ; Middle Aged ; Quality of Life

Objective To observe clinical efficacy of warm-promotion needling for the treatment of cold coagulation and blood stasis of primary dysmenorrhea.Methods Totally 120 patients with cold coagulation and blood stasis of primary dysmenorrhea were randomly divided into warm-promotion needling group (60 cases) and control group (60 cases). Warm-promotion needling group was treated with warm-promotion needling at Guanyuan (RN4), Sanyinjiao (SP6), Shiqizhui (EX-B8), and Diji (SP8), and cooperated with Ciliao (BL32), Hegu (LI4), and Taichong (LR3). Control group took same acupoints and applied uniform reforcing-reducing method. The two groups began treatment 5-7 d before menstruation, 1 times a day, for 7 times. The treatment was given 3 menstrual cycles. The visual analogue scale (VAS) and COX menstrual symptom scale (CMSS) were used to observe the pain degree at the end of 1, 2, 3 menstrual cycles. The clinical efficacy was evaluated 3 months after treatment.Results The scores of VAS and CMSS was obviously reduced in the two groups after the treatment compared with those before treatment (P<0.01). The synperiodic scores of VAS and CMSS in warm-promotion needling group was obviously lower than those in the control group (P<0.05). The total effective rate of warm-promotion needling group was 96.67% (58/60), and the control group was 73.33% (44/60), the difference was significant (P<0.05).Conclusion Warm- promotion needling can obviously relieve dysmenorrhea symptoms and shorten the time of pain of patients with cold coagulation and blood stasis of primary dysmenorrhea, which has affirmative clinical efficacy.

ObjectiveTo evaluate the laparoscopic procedure and therapeutic efficacy of retroperitoneal laparoscopic surgery for the treatment of adrenal ganglioneuroma.Methods6 patients [4 male and 2 female,32 to 59 (mean 41.3) years old],underwent retroperitoneal laparoscopic resection of adrenal ganglioneuroma. In this group, 2 patients with left adrenal ganglioneuroma, 4 patients with right adrenal ganglioneuroma. ResultsAll of the 6 cases was successfully performed uneventfully with retroperitoneal laparoscopic adrenalectomy. Pathologic studies confirmed there were 6 cases of adrenal ganglioneuroma. No case was transferred to open operation.The blood pressure remained stable during operation.Mean tumor size was (5.9±2.1) cm (tumor diameter 3.6-11.2 cm) Mean operative time was 120(90-210) min.Mean estimated blood loss was 160 (50-700) ml.Postoperative hospital stay ranged from 7 to 9 days.All the patients were cured without relapse during 4-32 month, follow-up. ConclusionsRetroperitoneal laparoscopic procedures for adrenal ganglioneuroma causes less traumatic;less operative blood loss;distinct image during operation;less postoperative discomfort;faster postoperative recovery and earlier return to daily activities and diet.Retroperitoneal laparoscopic procedure should be considered as the first choice for adrenal ganglioneuroma.

Foreign student education is an important task in medical colleges and universities.Clinical neurology teaching is very difficult because of its complex discipline.Neurologists in the First Affiliated Hospital of Chongqing Medical University summarized and analyzed the common problems including the training of teachers' ability to use language,teaching of basic subjects,clinical skills training,promotion of patients' compliance and implementation of regular tests so as to provide references for improving the quality of neurology teaching.

Tree shrews have an excellent visual system, their cones accounted for 96%of the photorecepter cells, so that their color vision and stereo vision are well developed.With their rich resources and low cost, tree shrews have been considered as an ideal animal model in eye research in comparative medicine and genomics research.The ophthalmological research on tree shrew mainly focused on the establishment of myopia model, as well as the changes in myopic sclera and choroids, and the basic studies of their retina, optic and visual cortex.This paper reviewed the basic ophthalmological re-search of tree shrew.

Continuous drug monitoring is a promising alternative to current therapeutic drug monitoring strategies and has a strong potential to reshape our understanding of pharmacokinetic variability and to improve individualised therapy.This review highlights recent advances in biosensing technologies that support continuous drug monitoring in real time.We focus primarily on aptamer-based biosensors,wearable and implantable devices.Emphasis is given to the approaches employed in constructing biosensors.We pay attention to sensors'biocompatibility,calibration performance,long-term characteristics stability and measurement quality.Last,we discuss the current challenges and issues to be addressed in continuous drug monitoring to make it a promising,future tool for individualised therapy.The ongoing efforts are expected to result in fully integrated implantable drug biosensing technology.Thus,we may anticipate an era of advanced healthcare in which wearable and implantable biochips will automatically adjust drug dosing in response to patient health conditions,thus enabling the management of diseases and enhancing individualised therapy.

Objective To evaluate the application value of real-time three-dimensional echocardiography (RT-3D TEE) in nonvalvular atrial fibrillation patients after transcatheter left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug (ACP).Methods The two-dimensional transesophageal echocardiography (2D TEE) and RT-3D TEE were performed in selected patients to measure the diameter of left atrial appendage ostium and landing zone,to observe left atrial appendage morphology and lobular distribution.These were also performed to guide the whole process of transcatheter LAAC with ACP,which included the atrial septal puncture,sheathing canal cruise,occluder device implantation,and verifying the stability of occluder device and releasing the device.It involved observing ACP occluder morphology,location,stability,surrounding residual shunt,whether influencing the mitral valve and left superior pulmonary vein flow,and pericardial effusion.Results A total of 15 patients (100％) successfully underwent LAAC with the ACP.The maximum diameter of left atrial appendage ostium by 2D-TEE measurement during operation was (20.5 ± 2.9)mm,located at 135°.The diameter of left atrial appendage landing zone was (17.1 ± 2.8) mm,located at 45°;(18.0 ± 4.0) mm,located at 90°;(22.1 ± 4.7)mm,located at 135°,respectively.The left atrial appendage morphology:2 had one leaf and 13 had two leaves or more,including 2 cases of bifoliate short neck shape.In 15 patients,6 cases of cauliflower type,2 cases of wind sock type,3 cases of chicken wing type,2 cases of cactus type and 2 cases of complex type.The proximal left atrial appendage morphology:3 cases of boot type,2 cases of wide mouth type,6 cases of narrow mouth type,2 cases of straight tube type,and 2 cases of bifoliate short neck type.There was no obvious residual shunt in all the patients at immediately post-operation.Conclusions In the transcatheter LAAC with the ACP,RT-3D TEE has important application value in the preoperative selection of patients,the choice of appropriate occluder,guidance of full-process monitoring during operation,the postoperative effect evaluation and so on.

Objective To prepare a new thrombus model by fluid model method , which is suitable for evaluation of mechanical thrombectomy devices for acute stroke.Methods The fluid model adopted the Chandler loop theory , while the static model adopted conventional method.Mechanical properties of thrombi prepared by fluid model and static model were measured by manual elongation test ( 15 samples in each group) and catheter injection test (15 samples in each group ).Histological structure was compared among the above thrombus models ( 5 samples in each group ) and specimens of five patients with stroke by hematoxylin-eosin staining method.Then, thrombi in fluid model were utilized to establish embolization of vessels in swine model ( two pigs ) for evaluation of radiopacity.Independent-Sample test was performed to compare the maximum tensile length of two methods , and Fisher′s exact test was used to compare the rate of thrombus fragmentation after catheter injection test.Results The maximum tensile length of two models were (4.28 ±0.23) and (3.16 ±0.13) cm, respectively, and the difference was statistically significant (t=16.38, P<0.01);After catheter injection, the fracture rates of thrombus were 13% (2/15) and 60%(9/15), which were also statistically significant (P<0.05).As to histological structure, thrombi prepared by fluid model showed mixed thrombus structure , which similar to thrombi of stroke patients , But thrombi prepared by static model were replete with erythrocytes under the microscope .A total of eight vessels ( lingual arteries and superficial cervical arteries ) in two swines were successfully occlusive ( TIMI 0 or 1 ) , and sufficient radiopacity of each injected thrombus was observed.Conclusions The thrombi prepared by fluid model not only have good mechanical stability and sufficient radiopacity , but their histological structure is similar to thromboemboli retrieved from cerebral arteries of patients with acute stroke.