Objective To describe the clinical characteristics of 4 patients with concomitant amyotrophic lateral sclerosis (ALS) and Sj(o)gren' s syndrome.Methods The clinical features,laboratory findings,and electrophysioiogical manifestations etc.of these patients were analyzed.Results Four female patients all developed progressively aggregated weakness in their limb/limbs at the fifth to sixth decades of their lives.According to their neurologic findings,3 met the criteria of clinical probable ALS,while the other was diagnosed with probable laboratory-supported ALS.All these patients showed diffused patterns of neurogenic changes in electromyography tests.Motor symptoms of 2 patients transiently improved after immunomodulation treatments.Conclusion Careful screening of the Sj(o)gren' s syndrome symptoms in patients with ALS is necessary so as to deal with the treatable concomitant disease in time.

Objective To study the application of total intravenous anesthesia(TIVA) in patients with larp-aroscopic cholecystectomy(LC). Methods 100 cases with LC were randomly and evenly assigned to two groups: the combined intravenous with inhalation anesthesia(CIIA) group(n = 50) and the TIVA group(n = 50). The maintain anesthesia. BP, HR and SpO2 at all stages and time for extubation,the consciousness were recorded. Results The pneumoperitoneum after 10 min HR(96.8±13.5)times/min,SBP(142.5±14.3) mmHg、DBP(93.0±14.3) mm-Hg in A group higher than before induction of anesthesia(82.3±12.5) times/min, (129.0±21.7) mmHg, (77.3±13.5) mmHg(P < 0.05～0.01) ; The pneumoperitoneum after 10 min HR (84.0±11.0) times/min, pneumoperito-neum comphte(76.3±9.0) times/rain in B group lower than the(96.8±13.5) times/min, (84.1±11.0) times/min in A group(P >0.05); B group patients completed the opening time(6.5±1.5) min、extubation time (11.5±1.4) min、pestoperative nausea and vomiting in 3 cases,after 8 h VAS value of (2.8±1.1) in group B were lower than the (10.5±2.8) min,(25.2±9.5)min,12 cases(5.4±2.1) in group A(t =2. 411, P <0.05). Conclusion The application of TIVA to LC anesthetic effect is satisfaction.

[Objective]To investigate the characteristics,treatment and prognosis of tibial plateau fracture of Schatzker type Ⅴ and Ⅵ and recommend the option of the surgical treatment.[Method]From May 2002 to March 2006,arthroscopically assisted double-plating fixation,locking plate with cannulated screws and external fixation with limited internal fixation were performed in 35 patients with tibial plateau fracture of Schatzker Ⅴ and Ⅵ.[Result]All patients were followed up from 12 to 35 months with an average time of 16.5 months.Bone union was achieved in all cases.According to Rasmussen's functional grading system,the excellent,good,fair and poor cases were 19,10,4 and 2,respectively.[Conclusion]CT 3D reconstruction,evaluation of soft tissues injury,suitable operation timing and approaches,anatomical reduction,bone transplantation,proper fixation and right rehabilitation training are all key factors to improve the therapeutic effects on tibial plateau fracture of Schatzker Ⅴ and Ⅵ.

Tropane alkaloids,such as hyoscyamine (or its more stable racemate atropine) and scopolamine,are remembered as the oldest drugs in medicine with wide pharmaceutical applications clinically for their mydriatic,antispasmodic,anticholinergic,analgesic and sedative properties.Presently,the supply of tropane alkaloids are entirely rested on their isolation from plant materials,yet the low contents of tropane alkaloids in plants raise the requirement to breed new varieties of high-yield tropane alkaloids and improving the production of tropane alkaloids in hairy root cultures or plants by biotechnology has be a research focus in the field of secondary metabolism.For the past decade,there have been important progresses on biosynthesis of tropane alkaloids and their molecular biology,some new pathway genes have been identified and many achievements have also been acquired in metabolic engineering of tropane alkaloids.This review summarized the recent advances in above aspects,and the problems and orientations of future research are also discussed and proposed.

Objective To observe the analgesic effect after cesarean section with different paregoric meth-ods. Methods 100 cesarean patients were randomly divided into A and B group. A group adopted patient controlled epidura analgesia(PCEA) micro-injection pump;B group using patient controlled intravenous analgesia(PCIA) mi-cro-injection pump,patients were observed and recorded for their pain, vomit disgustingly, exsufflation and the time of first urination or accidentally tube pull-out. Results The time of average surgery for A, B group were (53.5±8.5) min, (54.7±8.2) min, between the two groups was not significant (t=1.524, P>0.05) ; A group of visual Analog score (1.49±0.43) points were significantly higher than B group (1.13±0.56) points(t=2.119,P<0.05) ;the incidence of headache, dizziness, nausea and vomiting, skin itching(30.0%, 16.0% ,6.0%) in A group were signifi-candy higher than B group(16.0%,8.0% ,2.0%) (t=2.223, t=2.313, t=2.283, all P>0.05) ; the time of A first exhaust,voiding time[(24.56±8.77) h, (6.51±1.57) h] in A group were significantly higher than B group [(19.29±8.16)h,(4.06±1.76)h](t=2.445,t=2.415,P<0.05). Conclusion PCIA method was safe,effec-tive and allowed patients to have early activities after treatment and to promote early rehabilitation. It should be promo-ted for cesarean section.

Objective To investigate the feasibility and efficacy of using small intestinal submucosa (SIS) as scaffold in cystoplasty augmentation for treating the neurogenic bladder.Methods We retrospectively reviewed our database of 14 patients with neurogenic bladder,including ten male and four female,between January 2011 and March 2014.The mean age in those patients was 29 years old (range 14-56 years old).The etiology of neurogenic bladder included myelomeningoceles in 8 cases and spinal cord injuries in 6 cases.The urodynamic examination showed that the mean volume of maximal bladder pressure was (150.1± 64.2) ml,mean bladder compliance was (5.2± 3.9) ml/cmH2O,maximal detrusor pressure was (44.1 ± 29.2) cmH2O.The SIS cystoplasty was performed in all patients,which the Surgisis(R) ES was used during operation.In order to enlarge the bladder,the 4-layer tissue graft was fashioned into a strap shape,rehydrated and continuously sutured to the mucous edge of opening bladder walls.Seven patients accepted the ureter reimplantation with anti-reflux technique simultaneously.Serial video-urodynamics,magnetic resonance urography (MRU) and serum analyses were used to assess the outcomes of surgery.Results All patients were undergone the operation successfully.The mean operative time was 120 min.Bowel function returned promptly after surgery.No metabolic consequences were noted.Renal function was preserved.The duration of follow-up ranged from 6 to 48 months (mean 24 months).Compared to the preoperative findings,there were significant increasing in maximum bladder capacity (P＜0.05) at the 6,12 and 24-month follow-up (150.1± 64.2) ml preoperatively,(274.9±88.7) ml at 6 months,(322.5± 144.4) ml at 12 months and (279.9± 157.9) ml at 24 months,The significant differences also exhibited in the increasing of bladder compliance (P＜0.01) at the 24-month follow-up [(5.2±3.9) ml/cmH2O preoperatively,(26.1 ±29.4) ml/cmH2O at 24 months] and decreasing of maximum detrusor pressure (P＜0.05) at the 12 and 24-month follow-up [(44.1±29.2) cmH20 preoperatively,(20.1±9.8) cmH2O at 12 months,(20.2±19.1) cmH2O at 24 months].Two patients were observed scaffold rupture one week postoperatively and healed with patent drainage.One patient developed calculi in neo-bladder at 3-months follow-up and treated with transurethral lithotripsy.Four patients were noted vesico-ureteral reflux at 12-month follow-up.The botulin toxin detrusor injection was used in 2 cases.After indwelling the catheter for 3 months,the symptoms of reflux disappeared.The oral administration of solifenacin (5mg twice per day) and tolterodine (4mg once per day) was used in other 2 patients,who also accepted the catheter indwelling at the same time.The symptom of reflux relieved in only patient.Conclusions SIS can be used effectively as a scaffold for bladder augmentation.Tissue engineering technology provides a potentially viable option for genitourinary reconstruction in patients with neurogenic bladder.

A male patient, 49 years old with drug use, swallowed a toothbrush and a tube of 20 centimeters long which lead to the upper abdomen pain for six years. The gastroscopy examination showed the head of the toothbrush in the gastric antrum and the tail inserting in the pylorus. The intragastric toothbrush was removed by the gastroscopy combining with esophagoscopy.
Esophagoscopy ; Foreign Bodies ; surgery ; Gastroscopy ; Humans ; Male ; Middle Aged ; Stomach

Adrenal Hyperplasia, Congenital ; diagnosis ; Female ; Humans ; Infant, Newborn ; Male ; Neonatology ; Pregnancy ; Prenatal Diagnosis

Hepatic perfusion parameters play an important role in detecting and diagnosing diffusion diseases of liver. Based on a hemodynamic model. In this study, we described a fast and accurate method to calculate the perfusion parameters. First, we used a dual-input one-compartment kinetics model to illustrate the distribution of the contrast agent concentration among the body. Then, we used the Gaussian function to fit the scatter concentration data of portal vein and aorta, to obtain a liver agent concentration on function of time. Finally, we solved the model parameters by using Levenberg-Marquardt algorithm, and calculated the perfusion parameters. The results showed that the method proposed in this study could calculate the parameters precisely, and had a prosperous future application possibility.
Algorithms ; Contrast Media ; Hemodynamics ; Humans ; Liver ; physiology ; Models, Biological ; Perfusion