BACKGROUND: Botulinum toxin A has been applied to treat muscular convulsion by local injection and shows obvious effects in reducing muscular hypertonia with fewer side effects.OBJECTIVE: To assess the effect of botulinum toxin A on Meige's syndrome concerning facial convulsion, therapeutic effect, and side effects.DESIGN: Randomized self-control clinical study.SETTING: Neurological Department of Southwest Hospital Affiliated to the Third Military Medical University of Chinese PLA.PARTICIPANTS: Between June 2000 and May 2003, 24 outpatients were confirmed of having Meige's syndrome at the Neurological Department of Southwest Hospital, the Third Military Medical University of Chinese PLA and volunteered to receive botulinum toxin A (BTA) injection. Meige's syndrome was presented by convulsive eyelid closure in 10 cases, grinding teeth and smacking movement in 3 cases, involuntary blinking in 2 cases,frowning in 1 case, and mixed manifestations in 8 cases.METHODS: Totally 24 patients with Meige's syndrome were subjected to BTA injection at multiple spots of convulsive muscles by dosage of 2.5-5 U in each spot. Improvement of facial convulsion and curative effects were assessed at least once by clinical examination or telephone follow-up. Convulsion was graded in four degrees according to Cohen's scaling standard.Curative effects: [1] Complete alleviation: Convulsion was reduced to grade 0. [2] Obvious alleviation: Convulsion dropped by more than two grades. [3]Partial alleviation: Convulsion dropped by one grade. [4] Ineffective: Convulsion was not attenuated.MAIN OUTCOME MEASURES: [1] Changes of muscular convulsion intensity after BTA injection in patients with Meige's syndrome; [2] improvement of various symptoms after BTA injection; [3] side effects of BTA.RESULTS: Totally 24 patients entered the result analysis. [1] Before treatment, there were one case of grade 0- Ⅰ, 7 cases of grade Ⅱ, 10 cases of grade Ⅲ and 6 cases of grade Ⅳ, as compared to 16, 6, 2 and 0 cases, respectively, after treatment (χ2 = 95.489 4, P = 7.313 41×10-10). [2] BTA could alleviate eyelid convulsion in an average of 3 days, with curative effect reaching the peak in 2 weeks. Symptoms were found to be completely alleviated in 75% (18/24), obviously alleviated in 17% (4/24) and partially alleviated in 8% (2/24), with the total efficiency of 100%. The effective duration was 8-44 weeks with the average of 24.4 weeks. [3] Muscle weakness at the injected spot and incomplete muscular paralysis at the uninjected spots occurred for a short time after injection, but were alleviated automatically within 1-8 weeks.CONCLUSION: BTA can obviously reduce convulsive degree and enhance the effects in treating Meige's syndrome; moreover, selection of muscles to be injected into and injection spots will help reduce side effects.

Objective To investigate the diagnostic value of ultrasound elastography hardness score and area ratio to identify benign and malignant lesions.Methods 90 patients with breast lumps were selected and divided into the malignant and non -malignant group according to surgical pathology diagnosis,they were 40 cases (a total of 45 tumors)and 50 cases (a total of 57 tumors),two groups of patients were detected in ultrasound elastography,anal-ysis of imaging hardness ratings and area ratio and other information,to investigate the clinical diagnostic value. Results The ultrasound elastography of 50 cases with benign tumor were 0 -2 point,7 cases were 3 -4 point, 7 cases with malignant tumors were 0 -2 point,38 cases were 3 -4 point,the difference between the two groups were statistically significant (χ2 =28.55,P <0.05);The average area ratio of benign tumor was (1.01 ±0.27),malignant tumors was (2.28 ±1.68),the difference between the two groups was statistically significant(t =9.22,P =0.001);the sensitivity,specificity,accuracy of elastography hardness rating in diagnosis of malignant breast tumors were 87.72%,84.44%,86.27%,the area ratio method were 85.96%,86.67%,86.27%,joint inspection of the two groups were 96.49%,95.55%,96.08%,joint inspection had obvious advantages,the difference was statistically sig-nificant(χ2 =16.24,13.58,P <0.05).Conclusion Ultrasound elastography hardness rating combined area ratio has a higher accuracy rate for differentiating benign and malignant breast tumors.

Objective To investigate the value of Color Doppler ultrasound in hemodynamic changes of non-alcoholic fatty liver disease.Methods 120 cases with non -alcoholic fatty liver disease were selected and divided into the mild group,moderate group and severe group.According to the degree of fatty infiltration of the liver taxono-my,40 cases in each group,hemodynamic changes of each group were detected in Color Doppler ultrasound equip-ment.Results Hepatic venous pulse waveform analysis and comparison constituted of the three groups and control group,the difference was statistically significant (χ2 =25.343,P <0.05).PPVV,MPVV,HARI of the three groups and control group were compared,the difference was statistically significant(F =34.67,51.03,31.06,all P <0.05).Conclusion Color Doppler ultrasound which is used to detect hemodynamic changes in non -alcoholic fatty liver disease had good clinical value,can assess disease progression in patients,can provide the basis for clinical treat-ment.

Object To study the chemical constituents from the whole plant of Swertia przewalskii Pissjauk Methods The constituents were isolated on silica gel column chromatography and their structures were identified by spectral and chemical analysis Results Fifteen compounds were isolated and identified as 1, 7 dihydroxyl 3, 8 dimethoxyxanthone (Ⅰ), 1, 8 dihydroxyl 3, 7 dimethoxyxanthone (Ⅱ), 1, 7, 8 trihydroxyl 3 methoxyxanthone (Ⅲ), 1, 3, 7, 8 tetrahydroxyxanthone (Ⅳ), 1 O ? D glucopyranosyl 7 hydroxyl 3, 8 dimethoxyxanthone (Ⅴ), 1 O ? D glucopyranosyl 8 hydroxyl 3, 7 dime thoxyxanthone (Ⅵ), 7 O ? D glucopyranosyl 1, 8 dihydroxyl 3 methoxyxanthone (Ⅶ), 1 O D xylo pyranosyl (1→6) ? D glucopranosyl] 7 hydroxyl 3, 8 dimethoxyxanthone (Ⅷ), 1 7 hydroxyl 3, 8 dimethoxyxanthone (Ⅷ), 1 O D xylopyranos yl (1→6) ? D glucopytanosyl] 8 hydroxyl 3, 7 dimethoxyxanthone (Ⅸ), 8 8 hydroxyl 3, 7 dimethoxyxanthone (Ⅸ), 8 O D xylopyanosyl (1→6) ? D glucopyranosyl] 1, 7 dihydroxyl 3 methoxyxanthone (Ⅹ), luteolin (Ⅺ),? sitosterol ( Ⅹ 1, 7 dihydroxyl 3 methoxyxanthone (Ⅹ), luteolin (Ⅺ),? sitosterol ( ⅩⅡ ), oleanolic acid ( ⅩⅢ ), ursolic acid ( ⅩⅣ ) and getiopicroside ( ⅩⅤ ), respectively Conclusion Compounds Ⅳ～Ⅷ, Ⅺ, ⅩⅡ , ⅩⅣ and ⅩⅤ were obtained from this plant for the first time

Objective To investigate the clinical efficiency of Huayu Xiaozhong Decoction (HXD) on preventing peri-operative deep venous thrombosis (DVT) in lower limbs following artificial total hip replacement. Methods Ninety cases following artificial total hip replacement were randomized into blank control group, Rivaroxaban group and HXD group, 30 cases in each group, and were treated with brown sugar water, Rivaroxaban, HXD respectively. Before operation, and one, 3 and 14 days after operation, we monitored the changes of bleeding volume, DVT incidence, hemoglobin, prothrombin time ( PT) , activated partial thromboplastin time ( APTT) , international normalized ratio (INR), and D-dimer (DD) in the three groups. Results (1) Fifteen cases had DVT, with a total incidence rate of 16.67%. Of the 15 cases, 10 were from blank control group, 2 from Rivaroxaban group, and 3 from HXD group. ( 2) The amount of bleeding volume of Rivaroxaban group was larger than that of the blank control group and HXD group (P<0.05), but the bleeding was mild. (3) One, 3 and 14 days after operation, PT and APTT were shortened in blank control group (P<0.01 compared with those before operation). PT, APTT and INR were prolonged, and coagulation function was improved in Rivaroxaban group and HXD group, the differences being significant as compared with the blank control group ( P<0.05). HXD group had better effect on improving INR than Rivaroxaban group ( P<0.05). ( 4) In the three groups, hemoglobin level began to decrease on postoperative day one, arrived to the bottom on postoperative day 3 (P<0.05), and rose up near to the normal level on postoperative day 14; HXD group had higher hemoglobin level than blank control group and Rivaroxaban group on postoperative day 3 and 14 ( P<0.05). The 3 groups had higher plasma DD level than the normal level before the operation, arrived to the highest level on postoperative day one and 3 ( P<0.05) , and fell down near to the normal level on postoperative day 14. The inter-group comparison results showed that Rivaroxaban group and HXD group had lower DD level than the blank control group on postoperative day 3 and 14 ( P<0.05). Conclusion HXD is effective on preventing DVT in the peri-operation period through reducing bleeding, increasing hemoglobin level and improving postoperative anemia. The efficiency and safety of HXD are similar to Rivaroxaban.

In April 10, 2010, an earthquake measuring magnitude 7.1 shocked Yushu County,Qinghai province. For medical rescue, the National Earthquake Disaster Emergency Rescue Team was sent to Yushu right away. Rescue work in Yushu was faced with such difficulties as short preparative time, heavy workload, high exposure to various acute high altitude diseases (AHAD), and a number of other diseases frequently found on the cold plateau. To ensure the rescue work a success, the team took a series of measures including efficient preparative procedure, scientific and logical procedure in the emergency medical aid operations, reliable and effective handling of AHADs, along with sufficient self protection for team members.

Aim To determine whether AngⅡin para-ventricular nucleus (PVN)was involved in the chronic intermittent hypoxia (CIH ) induced-hypertension in rats.Methods Male Sprague-Dawley rats were ran-domly divided into Sham and CIH groups,the Sham rats were exposed to continuous normoxia,while the CIH rats were submitted to CIH (8 h per day for 15 days).The conscious noninvasive method with tail cuff was performed in rats to record the systolic blood pres-sure during establishing the model of CIH induced hy-pertension.Mean arterial pressure (MAP)and heart rate (HR)were recorded in vivo on a PowerLab data acquisition system after CIH.Rats were fixed on the stereotaxic instrument to conduct microinjection in the PVN.We used Western blot to measure Ang Ⅱ level and AngⅡtype 1 receptor (AT1 R)protein expression in PVN.Results The level of PVN Ang Ⅱin CIH rats was significantly higher than that in Sham rats,a-long with increased AT1 R protein expression.Microin-jection of Ang Ⅱ(0.03,0.3,3 nmol)in bilateral PVN dose-dependently increased MAP in both CIH and Sham rats,and this response was significantly augmen-ted in CIH rats.Losartan (50 nmol),AT1 R antago-nist,had no effect on MAP in Sham rats,but caused significant MAP decreases in CIH rats,and prevented Ang Ⅱ-induced increases in MAP in both CIH and Sham rats.Conclusion The results suggest that the increased AngⅡrelease and enhanced AT1 R activation in the PVN contribute to CIH induced-hypertension in rats.

Objective To prospectively evaluate the mid-term results of mitral annuloplasty using autologous pericardium for mitral valve insufficiency.Methods From April 2004 to December 2011,48 patients underwent mitral annuloplasty using autologous pericardium,the average length of pericardial strips was (51.9 ±2.8)cm.Carpentier classification was class Ⅰ in 5 cases,class Ⅱ in 41 cases,and class Ⅲ in 2 cases.The mitral valve repair techniques included quadrangular resection in 30 cases,valve repair in 7 cases,chordae transposition in 4 cases,edge to edge technique in 2cases,and artificial chordae tendineae in 3 cases.Concomitant procedures included one case arotic valve replacement,11 cases tricuspid valve repair,9 cases coronary artery bypass grafting,1 case coronary artery muscle bridge resection,and 1 case permanent pacemaker implant.Datum on long-term outcomes were obtained by questionnaires and by phone interview [average follow-up time (62.2 ± 21.3) months].Results Compared with preoperative datum,the diameters of left ventricular end diastolic diameter (LVDD) and left atrial diameter (LAD) examined by echocardiography show significant reduction in postoperative [(58.6 ± 1.7) mm vs (45.1 ± 1.3) ram,t =12.85,P ＜0.01 ; (50.6 ± 1.6)mm vs (38.0 ± 1.4)ram,t =9.58,P ＜0.01].There was early postoperative death in one case,cerebral infarction in one case,but none of patients died in late postoperative period.One patient had moderate mitral valve regurgitation in long-term follow-up.None of patients had redo operation and hemolytic complications.Conclusions Mitral annuloplasty using an autologous pericardium was an acceptable technique with low anticoagulation complications,permanent,well left ventricular function maintenance,and an economic method.

Objective To investigate the diagnostic value of computed tomography (CT) histogram analysis for thyroid malignant solitary coarse calcification nodules (MSCN).Methods A total of 89 thyroid solitary coarse calcification nodules (coarse calcification ≥5 mm,no definite soft tissue around calcification) confirmed either by surgery or histopathological examination in 86 patients enrolled in this study from Jan.2009 to Dec.2015 were evaluated,including 33 MSCN from 32 patients and 56 benign solitary coarse calcification nodules (BSCN) from 56 patients.Overall,27 cut-off values were calculated by N (4 ≤ N ≤ 30) times of 50 Hounsfield units (HU) in the range of 200 HU to 1500 HU,and each cut-off value and the differences in the corresponding area percentages in the CT histogram were recorded for MSCN and BSCN.The optimal cut-off value and the corresponding area percentage were established by receiver operating characteristic (ROC) curve analysis.Results In the 24 groups with an ROC area under the curve (AUC) of more than 0.7,at a cut-off value of 1150 HU and at an area percentage of no less than 98.4％,the ROC AUC reached a maximum of 0.86,and the accuracy,sensitivity,and specificity were 70.8％,93.9％,and 57.1％,respectively.At a cut-off value of 450 HU and at an area percentage of no less than 46.3％,the accuracy,sensitivity,and specificity were 76.4％,48.5％,and 92.9％,respectively.At a cut-off value of 550 HU and at an area percentage of no less than 81.5％,the accuracy,sensitivity,and specificity were 75.3％,33.3％,and 100％,respectively.Conclusions In comparison with the cut-off value of 1150 HU with an area percentage of no less than 98.4％,the sensitivities for the cut-off value of 450 HU with an area percentage of no less than 46.3％ and for the cut-off value of 550 HU with an area percentage of no less than 81.5％ were lower;however,the specificities increased significantly,providing an important basis for reducing the misdiagnosis of MSCN.

Objective To investigate the changes of serum C reactive protein (CRP),D-two polymer (D-D) and calcitonin (PCT) in patients with severe chronic obstructive pulmonary disease ( COPD) and its clinical value. Methods A retrospective analysis was conducted in 146 patients with severe COPD at acute attack in Tongji Huangzhou Hospital of Huazhong University of Science and Technology from December 2015 to December 2017.In addition,146 cases of COPD at remission stage (remission group) and 80 healthy subjects (control group) who were admitted to the hospital during the same period were selected.The serum levels of D -D,hs-CRP and PCT were compared among the three groups.At the same time,the levels of serum D-D,hs-CRP and PCT in patients with no bacterial infection or different pulmonary function classification were compared .Results The serum levels of D-D, hs-CRP and PCT in the acute group [(1 927.4 ±83.4) μg/L,(39.3 ±3.2) mg/L,(5.8 ±1.7) ng/mL] were significantly higher than those in the remission group [(314.2 ±69.2)μg/L,(16.4 ±3.4)mg/L,(1.8 ±0.7)ng/mL], which in the remission group were also significantly higher than the control group [(231.7 ±58.5) μg/L,(3.8 ± 1.5)mg/L,(0.4 ±0.1)ng/mL],the differences were statistically significant (F＝35.487,11.266,6.752,P＝ 0.001,0.005,0.000).The serum levels of hs -CRP and PCT in the acute phase combined with bacterial infection group[(41.4 ±1.7) mg/L,(6.4 ±1.4) ng/mL] were higher than those in the non bacterial infection group [(36.3 ±1.2)mg/L,(5.0 ±1.0)ng/mL](F＝16.541,4.467,P＝0.000,0.011),but there was no statistically significant difference in D -D level ( P ＞0.05).There were statistically significant differences in serum D -D, hs-CRP and PCT levels among patients with different pulmonary function classification [serum D-D:(2 083.5 ± 88.3)μg/L vs.(1 727.3 ±71.3)μg/L vs.(1 523.5 ±67.3)μg/L;hs-CRP:(63.8 ±19.5)mg/L vs.(29.5 ± 10.4)mg/L vs.(10.6 ±3.2) mg/L;PCT:(6.2 ±1.3) ng/mL vs.(3.4 ±0.9) ng/mL vs.(1.3 ±0.4) ng/mL] (F＝34.493,15.488,6.567,P＝0.000,0.001,0.018),and the higher the pulmonary function classification ,the higher the above indicators(all P＜0.05).Conclusion The levels of serum CRP,D-D and PCT in patients with severe COPD at acute attack are significantly increased ,and the increase of the patients with bacterial infection is more obvious,and the index level is positively correlated with the classification of lung function ,which can provide a reference for clinical practice.