Objective To evaluate the results and side effects in three dimensional conformal radiation therapy (3DCRT) for esophageal carcinoma. Methods From December 1996 to December 1998,67 patients with esophageal carcinoma were treated with 3DCRT(3DCRT group),in which all were treated once every other day to a total dose of 40 42 ?Gy in 13 15 days at 5 6?Gy per fraction totally 7 8 fractions, and during the same interval, another 112 patients treated by conventional fractionation radiotherapy(CF group) to a total dose of 64 68?Gy over 44 48 days at 2.0?Gy per fraction 5 days per week were analyzed and compared. Results The 1 ,2 ,3 and 4 year local control rates in 3DCRT group were 71.6% ,62.7%,49.3% and 43.3% ,compared to 53.6%, 43.8% ,33.9% and 25.9% in CF group (P = 0.011). And the survival rates in 1 ,2 ,3 and 4 years in 3DCRT group were 62.7%,52.2%,43.3% and 38.8%, as compared with 49.1%, 41.1% ,30.4% and 22.3% in CF group (P = 0.027). However, in the 3DCRT group, the incidence of acute radiation esophagitis was higher (P=0.003) and those of hematogenous side effects and B symptom were lower(P=0.007,0.021). Conclusion Compared with conventional fractionation radiotherapy,3DCRT is able to improve the local control rate of esophageal carcinoma, with tolerable acute and late radiation side effects.

OBJECTIVE:To explore the spasmolytic effect of baked Radix Vladimiriae on in vitro intestinal muscle in rabbits. METHODS:Magnus in vitro intestinal muscle accumulative dose method was adopted to observe the dose-effect relationship of petroleum ether parts of baked Radix Vladimiriae with in vitro intestinal muscle of rabbits and its impact on the spasm of rabbit intestinal muscle induced by acetylcholine, histamine phosphate and Bacl2. RESULTS:There was a certain dose-effect relationship between petroleum ether parts of baked Radix Vladimiriae and spasmolytic mechanism of rabbit in vitro intestine. It showed the effect of acetylcholine, histamine phosphate and Bacl2. CONCLUSION:The inhibition effect of petroleum ether parts of baked Radix Vladimiriae on normal in vitro intestinal muscle increase as long as dose increase. The inhibition mechanism may be associated with acetylcholine competing with histamine to block M receptor and H1 receptor as well as to inhibit excitability of intestinal muscle.

Objective To study the correlation between the electrophysiological features and mechanical ventilation and long?term outcome in Guil?lain?Barré syndrome(GBS)patients. Methods Electrophysiological and clinical data were retrospectively collected,and compared between venti?lated and not ventilated patients,as well as among each subtype of GBS. Results Totally 38 GBS patients were included in the study,among which 12(32%)were ventilated. The p/d CMAP ratio of the common peroneal nerve was significantly lower in ventilated group compared to not ventilated group(48.7±15.3 vs 80.8±24.0,P=0.005). AIDP was the most common subtype in ventilated patients compared with AMAN and undetermined (46%vs 0%and 9%,P=0.027). The long?term outcome score of AMAN was significantly lower than AIDP(4.3±1.3 vs 2.5±0.9,P=0.028). Conclusion Electrophysiological testing was predictive for mechanical ventilation and long?term outcome:low p/d CMAP ratio of the common pero?neal nerve was helpful for predicting mechanical ventilation,AIDP was prone to develop respiratory failure and had a worse outcome compared to AMAN.

Objective To retrospectively study the clinical and electrodiagnostic features in subacute combined degeneration of spinal cord (SCD)patients. Methods The clinical and electrodiagnostic recordings of all SCD patients conformed in our Neurology Department from Janu?ary 2013 to July 2015 were retrospectively reviewed. Totally 29 patients diagnosed as SCD,whom received no treatment before admitted in our hos?pital,were recruited for the study. Correlation analysis between serum level of vitamin B12(VB12),course of disease and degree of neural lesion was performed,and the electrodiagnostic features were summarized and analyzed. Results The course of disease had significant correlation with the degree of neural lesion(P=0.001),but there was no significant relevance between serum VB12 level and neural damage(P>0.05). Electrodi?agnostic examination revealed:The abnormal rate of motor nerve(15.20%)was lower than that of sensory nerve(42.75%,P<0.001)and the up?per limb nerve(27.1%)was lower than that of lower limb nerve(30.87%,P=0.578). There was no remarkable difference of abnormal rate in all kinds of nerves of motor and sensory nerve(P1=0.320,P2=0.755). In the analysis of the parameters of electromyograph,there was statistical signif?icance of the abnormal rates of compound muscle action potential(CAMP)between each motor nerve(P=0.005). There was statistical signifi?cance of the abnormal rates of CAMP and no function between each sensory nerve(all P<0.001). Conclusion The course of disease has signifi?cant correlation with the degree of neural lesion. Sensory nerve is tended to be betreffend than motor nerve. Phil.always nervous are more likely to be affected than others in motor nerve at CAMP. Tibial nerve is easier to be influenced at CAMP in sensory nerve ,and the lesion is more serious.

Objective To Btudy effect of standardized acupuncture combined with rehabilitation therapy (function training)on improvement of comprehensive function among patients with stroke in communities,Changning District of Shanghai.Methods One hundred and seventy-six stroke patients were divided into rehabilitation therapy group(88 cases)and control group(88 cages)with block randomization.Patients in rehabilitation therapy group were treated with standardized acupuncture combined with function training in addition to regular medical treatment,and patients in control group regular medical treatment only.All the patients were evaluated with functional comprehensive assessment(FCA)scale by the end of 2-and 5-month of treatment,respectively.Results By the end of 5-month of treatment,scores of FCA in both groups increased significantly (P＜0.01),as compared to those before treatment,more in rehabilitation therapy group than that in control group(P＜0.05).Conclusions Effect of standardized acupuncture combined with rehabilitation therapy Can obviously improve their comprehensive function among stroke patients in communities.

Objective To observe the visual field loss after 577 nm krypton pan-retinal photocoagulation (PRP) in the treatment of diabetic retinopathy (DR).Methods A prospective clinical studies.Forty-six eyes of 26 patients with proliferative DR (PDR) and severe non-proliferative DR (NPDR) diagnosed by clinical examination from No.306 Hospital of PLA during January 2014 and December 2015 were included in this study.Among them,21 eyes of NPDR and 20 eyes of PDR;13 eyes with diabetic macular edema (DME) (DME group) and 28 eyes without DME (non-DME group).All eyes underwent best corrected visual acuity (BCVA),fundus color photography,fundus fluorescein angiography (FFA) and optical coherence tomography (SD-OCT) examinations.The visual field index (VFI) and visual field mean defect (MD) values were recorded by Humphrey-7401 automatic visual field examination (center 30° visual field).The BCVA of DR eyes was 0.81 ± 0.28;the VFI and MD values were (89.8± 8.4)％ and-7.5 ± 3.85 dB,respectively.The BCVA of the eyes in the without DME group and DME group were 0.92±0.20 and 0.57±0.27,the VFI were (90.86±7.86)％ and (87.46± 9.41)％,the MD values were-6.86± 3.43 and 8.87 ± 4.48 dB.PRP was performed on eyes using 577 nm krypton laser.The changes of VFI,MD and BCVA were observed at 1,3,and 6 months after treatment.Results Compared with before treatment,the VFI of DR eyes decreased by 12.0％,12.3％ and 14.8％ (t=7.423,4.549,4.79;P＜0.001);the MD values were increased by-4.55,-4.75,6.07 dB (t=-8.221,-5.313,-5.383;P＜0.001) at 1,3 and 6 months after treatment,the differences were statistically significant.There was no difference on VFI (t=1.090,-0.486;P＞0.05) and MD value (t=-0.560,-0.337;P＞0.05) at different time points after treatment.Compared with before treatment,the BCVA was significantly decreased in DR eyes at 1 month after treatment,the difference was statistically significant (t=2.871,P＜0.05).Before and after treatment,the BCVA of the DME group was lower than that of the non-DME group,the difference were statistically significant (t=4.560,2.848,3.608,5.694;P＜0.001);but there was no differences on the VFI (t=1.209,0.449,0.922,0.271;P＞0.05) and MD values (t=1.582,0.776,0.927,1.098;P＞0.05) between the two groups.Conclusion The range of 30° visual field loss is about 12％-14.8％ after 577 nm krypton laser PRP for DR.VFI and MD can quantitatively analyze the and extent of visual field loss after PRP treatment.

Objective To explore the influencing factors of patients with post-stroke depression (PSD) and study their impact on the quality of life.Methods Fifty-two stroke patients admitted to the First ospital of China Medical University from February 2015 to May 2015 were randomly selected for the study,and these patients did not suffer depression as evaluated by the depression rating scale.Their age,history of diseases,types of diseases,cause of illness,disease area and treatments were collected in detail.These patients were followed up for six month.The mental state was assessed by Hamilton depressive scale (HAMD) and self-rating depressive scale (SDS).The life quality was evaluated by stroke specific quality of life score (SS-QOL) and modified Rankin scale(mRS).These data were selected by stratified sampling method and analyzed by SPSS 17.0 software.Results The incidence of PSD in elder patients (≥ years) was significantly higher than in the younger patients (P ＜ 0.05).Patients with cardiogenic cerebral embolism are more likely to suffer from PSD (P ＜ 0.05).The patients with infarction in different regions have different probability to suffer from PSD.Those patients with cerebral infarction in basal ganglia exhibited more possibility on PSD than others (P ＜ 0.01).Previous disease,including hypertension,diabetes and coronary disease,had no effects on PSD.There were no significant effects of stroke types and thrombolytic therapy on PSD.PSD had an unfavorable effect on the life quality of the patients.Conclusion The patients with cerebral infarction in basal ganglia,aged over sixty and cardiogenic cerebral embolism are prone to PSD,and we should pay more attention to them.PSD has a negative impact on the quality of life of patients.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objective:To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score (PHES) in mild hepatic encephalopathy(MHE) of patients with liver cirrhosis, so as to optimize the PHES.Methods:This was a prospective, multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium. Twenty-six hospitals from 13 provinces, autonomous regions and municipalities countrywide participated in this study, induding Tianjin Third Central Hospital, the Fourth People′s Hospital of Qinghai Province, the Second Affiliated Hospital of Baotou Medical College, the Third People′s Hospital of Taiyuan, the Fifth Medical Center of PLA General Hospital and so on. From October 2021 to February 2022, outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled. All patients received 5 PHES subjects in the same order: number connection test(NCT)-A, NCT-B, digit symbol test(DST), line tracing test(LTT) and serial dotting test(SDT), and the scores were calculated. The total score of PHES <-4 was taken as the cut-off value for diagnosing MHE. Compare the differences in each subtest between MHE group and non-MHE group. Receiver operating characteristic curve(ROC) and area under the curve(AUC) was performed to assess the diagnostic value of independent and combined subtests in MHE. Mann-Whitney U test and DeLong test were used for statistical analysis. Results:A total of 581 patients with liver cirrhosis were enrolled, 457 were diagnosed as MHE, and the incidence of MHE was 78.7%. The results of NCT-A, NCT-B, SDT, LTT, DST of MHE group were 60.00 s(47.01 s, 88.00 s), 90.45 s(69.32 s, 125.35 s), 74.00 s(57.65 s, 96.60 s), 74.72(60.00, 98.61) and 27.00(20.00, 36.00), respectively. Compared those of non-MHE group(34.00 s(29.15 s, 44.48 s), 50.00 s(40.98 s, 60.77 s), 50.00 s(41.07 s, 63.03 s), 46.23(38.55, 59.42) and 42.00(34.00, 50.75)), the differences were statistically significant( Z=12.37, 12.98, 9.83, 11.56, 10.66; all P<0.001). The AUC(95% confidence interval(95% CI)) of subtests of PHES NCT-B, NCT-A, LTT, DST and SDT alone in MHE diagnosis were 0.880(0.849 to 0.910), 0.862(0.828 to 0.896), 0.838(0.799 to 0.877), 0.812(0.772 to 0.851) and 0.788(0.743 to 0.832), respectively. The combination of 2 PHES subtests significantly increased the diagnostic efficacy. Among them the diagnostic efficacy of the combination of NCT-B and LTT was the best, the AUC(95% CI) was 0.924(0.902 to 0.947), the specificity was 91.9% and the sensitivity was 79.2%, which was better than a single PHES subtest (NCT-A, NCT-B, SDT, LTT and DST) and the combination of NCT-A and DST(AUC was 0.879, 95% CI0.847 to 0.910) which was recommended by guidelines on the management of hepatic encephalopathy in cirrhosis, the differences were statistically significant ( Z=3.78, 3.83, 5.57, 5.51, 5.38, 2.93; all P<0.01). Furthermore, compared between the combination of NCT-B and LTT and the combination of 3 subests of PHES, only the diagnostic efficacy of combination of NCT-B, LTT and SDT (AUC was 0.936, 95% CI 0.916 to 0.956) was better than that of the combination of NCT-B and LTT, the difference was statistically significant( Z=2.32, P=0.020). Conclusion:Based on the diagnostic efficacy and clinical feasibility of PHES subtests and their combinations, the combination of NCT-B and LTT is recommended for the diagnosis of MHE.