Objective To investigate the cause of refractory hiccups. Method 34 patients with refractory hiccups admitted to our hospital from January 1996 to December 2003 were examined with gastroscopy. The correlation of hiccups with reflux esophagitis and the efficacy of omeprazole treatment were studied. Results 10 patients were proven endoscopically to have esophagitis and duodenal ulcer, and the other 24 were suffering from esophagitis. According to Tokyo classification, 14 cases were having grade III esophagitis, and 20 were grade IV. All patients received omeprazole 20mg twice daily and cisapride 10mg thrice daily, and hiccups disappeared after 3 days. Conclusion Refractory hiccups may be the initial or primary symptom in moderate-severe esophagitis in aged people. Proton pump inhibitor therapy is effective in stopping refractory hiccup.

Objective To investigate the effects of Chinese herbal medication combined with nutrition intervention on perioperative nutrition in patients with colon carcinoma.Methods Ninety-six patients with colon carcinoma were divided according to their odd or even number into the control group and the intervention group.The former were given routine nutrition and the latter Chinese herbal medication combined with nutrition intervention.Then the mini-nutritional assessment(MNA)was used to assess the changes before and after operation and the complications.Results The intervention group was significantly better than the control one in terms of all nutrition factors but hematoglobin(P<0.05).The incidences of complication and dystrophy in the intervention group were lower than in control group(P<0.05).Conclusion The application of Chinese herbal medication combined with nursing intervention is important for the improvement of their nutrition and the reduction of postoperative complications.

Objective To study the influence of Langchuang Ⅱ,a Chinese medicinal compound formula,on Th1/TH2cytokines of MRL/lpr lupus mice.Methods Forty MRL/lpr mice with spontaneous systemic lupus erythematosus(SLE) were randomized into blank control group,LangchuangⅡgroup(in the dose of 20 g?kg-1?d-1),prednisone group(in the dose of 6 mg?kg-1?d-1),and the combination group(LangchuangⅡand prednisone).After medication for 8 continuous weeks,Flowcytomix technology was used for the detection of different kinds of serum Th1/Th2 cytokines.Results Compared with the blank control group,serum granulocyte-macrophage colony-forming unit(GM-CSF) level was decreased in the combination group(P0.05);IL-4,IL-5 and IL-10 were all decreaed in the medication groups,and the decrease of IL-10 was obvious in the combination group(P

Objective To predict the response of induction chemotherapy in advanced nasopharyngeal carcinoma (NPC)by using pretreat-ment apparent diffusion coefficient (ADC)values.Methods 35 patients with advanced NPC underwent DWI examination prior to 2-week in-duction chemotherapy.The patients were divided into CR (complete response)group,PR (partial response)one and SD (stable disease)one according to the tumor response of treatment.The effective responders included CR and PR groups.The patients were divided into children-adolescents(below 20 years)group and adults one according to the age,into non-keratinizing undifferentiated carcinoma group and non-kera-tinizing differentiated carcinoma one according to the pathological type,and also into T2,T3 and T4 groups according to the T-staging (UICC2010).Statistical analysis was used to compare the pretreatment ADC values between different groups.Results The average pre-treatment ADC values of CR,PR,responders and SD groups were (0.70±0.06)×10 -3 mm2/s,(0.72±0.04)×10 -3 mm2/s,(0.71± 0.04)×10 -3 mm2/s and (0.85±0.02)×10 -3 mm2/s respectively.The average pretreatment ADC value of the SD group was signif-icantly higher than that of PR group and responders,and the differences were significant (P <0.05).The average pretreatment ADC value of children-adolescents and adults groups were (0.73±0.07)×10 -3 mm2/s and (0.75 ±0.07)× 10 -3 mm2/s,which showed no significant differences.The average pretreatment ADC value of non-keratinizing undifferentiated carcinoma and non-keratinizing dif-ferentiated carcinoma groups were (0.76 ±0.08)×10 -3 mm2/s and (0.74±0.06)×10 -3 mm2/s,which showed no significant differ-ences.The average pretreatment ADC values of T2,T3 and T4 groups were (0.78±0.05)×10 -3 mm2/s,(0.77 ±0.07)×10 -3 mm2/s and (0.75±0.08)×10 -3 mm2/s.Although there were no significant differences between T2,T3 and T4 groups,a trend towards lower ADC was observed with increasing tumor T-staging.Conclusion Pretreatment ADC value is a valuable quantitative parameter,and it can be used for predicting induction chemotherapy response in advanced naso-pharyngeal carcinoma.

Objective To evaluate the discrepancy of parameters generated on dual-energy spectral CT (DECT)imaging in the different pathological grade of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC),and to provide helpful information of the prognosis and the guide of clinical treatment.Methods 61 patients with pathologically confirmed LHSCC who underwent contrastenhanced DECT before therapy were retrospectively analyzed.The enhanced monochromatic data were analyzed with workstation.Iodine concentration of lesion (IC),water concentration of lesion (WC)and slope of spectral HU curve (s-SHC)were acquired.According to cell differentiation,all patients were divided into well,moderately and poorly differentiated groups.The difference of IC,WC,s-SHC,constituent ratio of T stage were compared among different groups.Results The IC and s-SHC had significant difference among well,moderately and poorly differentiated groups(F =3.56,3.96 respectively,P <0.05).The two-two paired comparisons demonstrated that there were significant difference of IC between poorly and well differentiated group(P <0.05).The others two-two paired comparisons demonstrated no significant difference (P>0.05).There were no significant difference of WC among three groups respectively (H =0.84,P >0.05).χ2 test showed that there was no significant difference for the constituent ratio of T stage among three groups (P >0.05).Conclusion IC and s-SHC can help to judge the pathological grade of LHSCC,and they may be useful to evaluate the prognosis of LHSCC.

Objective To summarize the CT features of anaplastic thyroid carcinoma (ATC).Methods CT manifestations of 12 patients with ATC confirmed by surgery or biopsy were analyzed retrospectively.Results 1 1 (91.7%)patients had single lesion. The lesions appeared as low attenuation mass with cord-like,flocculent or patchy high attenuation areas.The lesions had mild to moderate enhancement in 1 1 cases (91.7%).Coarse calcifications were detected in 8 cases (66.7%),4 of them were incomplete rim or eggshell.11 cases (91.7%)showed invasion into adjacent structures,including trachea (6 cases,50%),esophagus (4 cases,33.3%),strap muscles (7 cases,58.3%),larynx (2 cases,1 6.7%),blood vessels (6 cases,50%).5 cases (41.7%)had tumor thrombus in the internal jugular vein.10 cases (83.3%)had lymph nodes metastasis.The enhancements of lymph nodes were divided into 3 types:mild homogeneous enhancement (4 cases,40%),mild enhancement with internal low-attenuation areas (7 cases,70%)and ring-like enhancement without internal enhancement (7 cases,70%).Conclusion CT features of ATC include low-density mass with cords,flocculent and patchy high-density areas,coarse calcification and mild to moderate enhancement,invasion to adjacent structure and lymph node metastasis with necrosis are common.

Objective To evaluate the feasibility of applying spectral CT material suppressed iodine (MSI) imaging as virtual plain CT scan to replace traditional non-contrast (TNC) CT in head and neck neoplasms. Methods A total of 52 patients with initial diagnosis of head and neck neoplasms underwent TNC CT scanning and spectrum mode enhanced scanning in the head and neck with spectral CT. With GSI Volume Viewer software from GE AW4.6 workstation, the enhanced scanning data were processed and MSI images were acquired. The CT values of different tissues (fat, erector spinae, cervical vertebrae, thyroid, and brain parenchyma) and the enhancement rate in erector spinae, carotid sinus were compared between MSI and TNC images. Image quality was objectively evaluated in noise and SNR for MSI and TNC images, while the subjective evaluation included the visibility of lesions, subjective acceptance rate, diagnostic efficacy (with/without lesions or lesion calcification, necrosis). Radiation dose including volume CT dose index (CTDIvol) and effective dose (ED) was compared between MSI and TNC. Results (1) CT values of erector spinae on MSI and TNC imaging were(52 ± 6)and(52 ± 7)HU respectively, and the difference between the two image modes was not significant(t=0.39,P>0.05). CT values on MSI and TNC Imaging were[-74 (-86,-59)HU]and[-79(-73,-61)HU]for fat (Z=-2.71, P<0.05),[139(121,196)HU]and[282 (237,336) HU,Z=-5.46]for vertebrae (Z=-5.46, P<0.05),[57(48,61)HU]and[96(74,110) HU]for thyroid (Z=-4.85, P<0.05),[35(32,39)HU]and[35(32,39)HU]for brain parenchyma (Z=-4.74, P<0.05) respectively. (2) There was no significant difference in enhancement rate of erector spinae between MSI and TNC imaging 1.15(1.07,1.20) and 1.14(1.03,1.26) respectively, Z=-5.50, P>0.05). The difference of carotid sinus enhancement rate was significant 5.75(4.70,6.73) and 4.37(3.91,5.61) respectively, Z=-5.50, P<0.05). (3) The noise of MSI[10.61(8.34,13.57) HU)]was higher than that of TNC [9.32(7.40,11.42) HU](Z=-2.52,P<0.05), and the SNR of MSI [-6.59(-8.59—-4.25)] was lower than that of TNC[-7.94(-10.25,-5.51)] (Z=-2.73,P<0.05). (4) Median scores of subjective imaging quality evaluation were 4(3.00,4.75) and 4(3.00,4.00) in MSI and TNC images respectively, and the difference was not significant(Z=-0.45,P>0.05).Unacceptable and acceptable cases in imaging quality of MSI were 3 and 49 respectively, while those were 2 and 50 in TNC group. Subjective acceptance rate between MST and TNC images was not significantly different(?2=0.01,P>0.05). (5) Diagnostic performance evaluation showed that the consistency of two observers was good in detecting lesions, necrosis and calcification between MSI and TNC image, with K value 0.93, 0.83 and 0.90 respectively (P<0.05). (6) Radiation doses between pure energy spectrum enhanced mode and conventional pre plus post contrast enhanced mode were compared. And differences of CTDIvol[11.78(10.98,17.30) mGy]and[23.89 (22.42, 29.98) mGy] respectively],ED [1.89(1.63,2.29) mSv]and[3.77(3.21,4.16 ) mSv] respectively] were significant(Z=-6.28, P<0.05). Pure energy spectrum enhanced mode reduced 39.07% of CTDIvol and 45.75%of ED respectively. Conclusions MSI imaging can be a potential substitute for TNC imaging. And it has clinical values in the diagnosis of head and neck neoplasms.

Objective To evaluate the efficacy of transarterial chemoembolization (TACE) and percutaneous cryosurgery sequential therapy for unresectable hepatocellular carcinoma (HCC).Methods Four hundred and twenty patients with unresectable HCC were divided into sequential TACE-cryosurgery sequential (sequential) group (n=290) and cryosurgery alone (cryoalone) group (n = 130). TACE was performed with the routine operation; the percutaneous cryosurgery was conducted 2 to 4 weeks after TACE. The patients were followed up at the first month and once every 2 to 3 month later. Liver ultrasound or both computer tomography and alpha fetal protein were examined during follow-up. Results During a mean follow-up of (42±17) months (range from 24 to 70 months), the local recurrence rate of ablated lesion was 17% for all the patients, 11% and 24% for patients in sequential group and cryoalone groups respectively (P=0. 001). The overall 1-, 2-, 3-, 4-and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1- and 2-year survival rates (71% and 61 % ) in sequential group were similar to those (73 % and 54 % ) in cryo-alone group (P=0.69 and 0. 147), while the 4- and 5-year survival rates were higher in sequential group (49 % and 39 % ) than those (29 % and 23 % ) in cryo-alone group (P= 0.001). Eighteen patients with large HCC (＞5 cm in diameter) in sequential group survived for more than 5 years while no one in cryo-alone group. Complication rate was 24% in all patients, 21% and 26% for the sequential and cryo-alone groups respectively (P=0. 06). The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group (P=0. 02). Liver crack occurred in two patients of the cryoalone group. Conclusions Pre-cryosurgical TACE increased the cryoablation efficacy and decrease its complications, especially hepatic bleeding. TACE and cryosurgery sequential therapy may be a better treatment for unresectable HCC, especially for large HCC.

Objective To observe the interfering effect of different doses of penehyclidine hydrochloride (PHC) on the mRNA expressions of nuclear factor kappa B (NF-κB) and inducible nitric oxide synthase (iNOS) in the lung tissue of rats with traumatic shock so as to investigate the protective role of PHC in secondary long injury following traumatic shock and the underlying mechanism.Methods The traumatic shock model was established.A total of 104 Wistar rats were randomly divided into four groups:control group,shock group,low dose PHC group ( P1 group) and high dose PHC group ( P2 group).At the beginning of resuscitation,the rats in P1 and P2 groups were given transjugular intravenous injection of 2 ml/kg isotonic saline containing 0.15 mg/kg and 0- 45 mg/kg PHC respectively,while the rats in shock and control groups were injected only isometric isotonic saline.The rats in the four groups were killed at 2 h,6 h,12 h and 24 h after resuscitation respectively to detect the mRNA expressions of NF-κB and iNOS by using RT-PCR and determine the lung wet/dry weight (W/D) ratio,lung permeability index (LPI) and lung injury score (LIS).Results The mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS at all the time intervals in the shock,P1 and P2 groups were all significantly increased as compared with those in the control group (P＜0.05).Howerver,the P2 group showed significant reduction in aspects of the mRNA expressions of NF- κB and iNOS,lung W/D ratio,LPI and LIS at all time points and P1 group also had significant decrease regarding the mRNA expressions of NF-κB and iNOS,lung W/D ratio at2 h,6 h,and LPI and LIS at 2 h,6 h,12 h,as compared with the shock group.Meanwhile,P2 group showed evident decrease at 6 h concerning the mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS as compared with P1 group (P ＜ 0.05 ).Conclusions PHC,especially at a large dosage,can significantly mitigate the long injury secondary to traumatic shock,and the mechanism may be associated with the inhibition of mRNA expressions of NF-κB and iNOS.

Objective The aim of this study was to determine whether multi?parameters MRI of tongue carcinoma have the potential to predict cervical lymph node metastases. Methods A total of 46 patients with tongue carcinoma, who underwent MRI scan preoperatively, were investigated retrospectively and were divided into cervical lymph node (LN) metastases group (unilateral LN+, n=16;bilateral LN+, n=14) and no cervical lymph node metastases group (LN-, n=16) according to their pathological grading. Of the 40 patients with tongue carcinoma underwent plain and contrast MRI scan, 6 patients have plain MRI scan, and 32 have DWI examination.The ADC value, tumor length, tumor thickness, sublingual distance between tumor and sublingual space, and para?lingual distance between tumor and tongue midlinedetermined from MRI, were preoperatively estimated and compared with the pathological findings of cervical lymph nodes. A unpaired t test was used to analyze normal distributed continuous data, and a Mann?Whitney U test was used to analyze abnormally distributeddata. The ROC was used to evaluate the efficacy of MRI in predicting the metastasis of cervical lymph nodes. Results The indexes of ADC value, tumor length, tumor thickness, and para?lingual distance between tumor and tongue midline, which all showed significant difference between LN+group and LN-group (all P<0.05), and the index of sublingual distance between tumor and sublingual space showed no significantly association with LN+ (P>0.05). The index of ADC value showed significant difference between unilateral LN+group and bilateral LN+group (P<0.05), and the other indexes, which all showed no significantly association with bilateral LN+ (all P>0.05). The ROC curve analysis of the ADC value, tumor length, tumor thickness, and para?lingual distance between tumor and tongue midline of the neck lymph node metastasis were carried out, with the cutoff set as 1.13×10?3 mm2/s, 31.08 mm, 17.33 mm and-2.26 mm. The corresponding area under curve(AUC), sensitivity, and specificity were 0.878, 90.9%and 90.0%; 0.822, 83.3% and 81.3%; 0.834, 86.7% and 81.3%; 0.794, 86.7% and 75.0%, respectively. The ROC curve analysis of the ADC of the bilateral neck lymph node metastasis was also carried out, with the cutoff of ADC value set as 1.07×10?3 mm2/s, the corresponding AUC, sensitivity, and specificity were 0.806, 80.0%and 75.0%. Conclusion The ADC value, tumor length ,tumor thickness and para?lingual distance between tumor and tongue midline,determined from MR imaging, all can be used as independent factors in predicting cervical lymph node metastasis, where ADC value may be helpful to predict bilateral neck lymph node metastasis.