With the rapid progress of rehabilitation in China, how to construct the accreditation system of physical therapy (PT) education has become a critical consideration. This article introduced the background, role, management and process about the accreditation system of PT education in United States in order to promote the development of PT education in China.

Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients over 80 years old with biliary-pancreatic diseases. Methods One hundred and twenty patients over 80 years old who underwent ERCP between January 2004 and April 2008 were retrospectively analyzed. The clinical efficacy, safety and complication were observed and followed up. Results One hundred and seventeen patients successfully underwent therapeutic ERCP and the success rate was 97.5%. All diseases of the patients included cholangiocarcinoma in 22 cases, duodenal papilla carcinoma in 3 cases, pancreatic carcinoma in 8 cases, acute pancreatitis in 15 cases, chronic pancreatitis in 5 cases, acute suppurative cholangitis in 9 cases and choledocholithiasis in 58 cases. During the procedure of ERCP, 3 cases failed to insert the duodenoscope, 3 cases were found hemobilia and 2 cases were found acute pancreatitis. Conclusions Therapeutic ERCP is effective and safe in elderly patients over 80 years. Age is not the contraindication of therapeutic ERCP.

Goiter, Nodular ; complications ; diagnosis ; Humans ; Lymphatic Diseases ; complications ; diagnosis ; Thyroidectomy

Objective To investigate the characteristic of vastus lateralis (VL) and vastus medialis (VMO) during the Taijiquan exercise with surface electromyography (EMG). Methods 15 healthy adults were collected their median frequency (MF), mean power frequency (MPF), zero crossing rate (ZCR), averaged EMG (AEMG) of bilateral VL and VMO when they maintained 5 Taijiquan typical posture. Results The differences were not significant in all those indexes between VL and VMO during the postures of Baihe Liangchi and Jinji Duli, and were significant during the postures of Louxi Aobu, Shizi Tui, Pubu (P<0.05), the VL's indexes were less. Compared with the maximum voluntary contraction, Taijiquan was the lower loaded, and more slow muscle fibers could be recruited. Conclusion Taijiquan is a lower loaded exercise, and more slow muscle fibers can be recruited, especially in the VMO in some actions.

Objective: To investigate the effects of Tiaozhi mixture on lipid metabolism disorder in patients with chronic hepatitis C virus infection and fatty liver. Methods: The clinical data of 122 cases of patients with chronic hepatitis C virus infection and fatty liver admitted to our hospital from January 2016 to January 2017 were retrospectively analyzed. Control group was only given antiviral treatment, and observation group was given antiviral treatment and Tiaozhi mixture. The blood lipids parameters, decrease of HCV RNA load, negative conversion rate of serum anti-HCV. Results: After treatment, the levels of blood lipids, i. e., triglycerides (TG), total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) were decreased significantly in the two groups, and the decreases of blood lipid levels of TG, TC and LDL-C in observation group were greater than those in control group. The level of high density lipoprotein-colesterol (HDL-C) was increased significantly in observation group, and the level of HDL-C in control group was basically unchanged. The liver function tests for alanine aminotransferase (ALT) and total bile acid (TBA) levels were all decreased effectively, and the decrease in observation group was greater than that in control group, and the aspartate aminotransferase (AST) level in the two groups was reduced, but there was no significant difference between the two groups. The decrease of HCV RNA load and negative conversion rate of serum anti-HCV in observation group were higher than those in control group. There was no significant difference in the incidence rate of adverse reactions between the two groups after treatment(χ²=0.000, P=1.000). Conclusions In the clinical treatment of chronic hepatitis C virus infection with fatty liver, combined Tiaozhi mixture can effectively increase the antiviral efficacy, reduce the possibility of adverse reactions, and help patients with liver function recovery, and it has high safety. Thus it is worthy of clinical promotion.

OBJECTIVETo study the antifertility and anti-inflammatory effects of compound Kucen gel in vivo.

METHODSAs antifertility experiment, we randomly divided 60 female SD rats into six groups of equal number: normal saline, blank gel, low-, medium- and high-dose compound Kucen gel (0.05, 0.10 and 0.15 g/g), and positive control (4% nonoxynol gel) to receive intravaginal administration of 200 microl of respective agent, followed by copulation with male rats in a 1:1 ratio. At 12 days after successful mating, the female rats were dissected for calculation of the embryos and the rate of contraception. As an anti-inflammatory trial, we established a mouse model of inflammation by applying xylene to the pinna, and equally randomized 60 Kunming mice to six groups as in the former experiment. We determined the degrees and average rates of swelling inhibition in the left ear.

RESULTSHigh-dose compound Kucen gel achieved a fertility-inhibition rate of 100% in the female rats, the number of embryos significantly lower than in the normal saline group (0.00 +/- 0.00 vs 11.00 +/- 2. 00, P < 0.05), but with no statistically insignificant difference from that of the positive control (0.00 +/- 0.00, P > 0.05). High-dose compound Kucen gel also markedly suppressed swelling in the left ear of the mice, with an inhibition rate of 52.3%, the average swelling degree significantly lower than in the normal saline group (10.17 +/- 2.56 vs 21.32 +/- 3.17, P < 0.01), but not remarkably different from that of the positive control (8.53 +/- 1.89, P > 0.05).

CONCLUSIONCompound Kucen gel, with its strong antifertility and anti-inflammatory effects, deserves further study and clinical application.

Animals ; Anti-Inflammatory Agents ; pharmacology ; Contraceptive Agents ; pharmacology ; Disease Models, Animal ; Drugs, Chinese Herbal ; pharmacology ; Female ; Gels ; Inflammation ; Male ; Mice ; Mice, Inbred Strains ; Rats ; Rats, Sprague-Dawley

Objective To evaluate the efficacy and safety of epalrestat, an aldose reductase inhibitor, and epalrestat plus methylcobalamine on diabetic peripheral neuropathy, as compared with methylcobalamine. Methods A total of 444 subjects with diabetic neuropathy were enrolled in the study, and divided into methylcobalamine group ( n= 145 ) , epalrestat group ( n = 143 ) , and methylcobalamine combined with epalrestat group ( n = 156 ) . Therapeutic efficacay was assessed in terms of clinical symptoms and physical examinations by using Michigan Neuropathy Screening Instrument ( MNSI ) , and electrophysiological assessments. Results After 4 to 12-weeks′treatment, symptoms and signs of neuropathy ( using MNSI ) are significantly improved in the three groups ( P<0. 01). The mean changes of MNSI ( questionnaire) score from baseline were higher in epalrestat group and methylcobalamine combined with epalrestat group as compared with that of methylcobalamine group(P<0. 05), but no difference was detected in the change of MNSI ( physical examination ) score from baseline among three groups. After treatment for 12 weeks, motor nerve conduction velocity ( MNCV ) was significantly improved in epalrestat group and methylcobalamine combined with epalrestat group(P<0. 05), but no difference was detected in MNCV at 12 week among three groups(P>0. 05). Conclusion Epalrestat is effective and safe in the treatment of diabetic neuropathy. Furthermore, epalrestat is more efficacious in ameliorating symptoms and MNCV of neuropathy than methylcobalamine. However, while no improved efficacy is shown with the combined treatment.

BACKGROUNDData of classical inborn errors of metabolism (IEM) of amino acids, organic acids and fatty acid oxidation are largely lacking in Hong Kong, where mass spectrometry-based expanded newborn screening for IEM has not been initiated. The current study aimed to evaluate the approximate incidence, spectrum and other characteristics of classical IEM in Hong Kong, which would be important in developing an expanded newborn screening program for the local area.

METHODSThe laboratory records of plasma amino acids, plasma acylcarnitines and urine organic acids analyses from year 2005 to 2009 inclusive in three regional chemical pathology laboratories providing biochemical and genetic diagnostic services for IEM were retrospectively reviewed.

RESULTSAmong the cohort, 43 patients were diagnosed of IEM, including 30 cases (69%) of amino acidemias (predominantly citrin deficiency, hyperphenylalaninemia due to 6-pyruvoyl-tetrahydropterin synthase deficiency and tyrosinemia type I), 5 cases (12%) of organic acidemias (predominantly holocarboxylase synthetase deficiency) and 8 cases (19%) of fatty acid oxidation defects (predominantly carnitine-acylcarnitine translocase deficiency). The incidence of classical IEM in Hong Kong was roughly estimated to be at least 1 case per 4122 lives births, or 0.243 cases per 1000 live births. This incidence is similar to those reported worldwide, including the mainland of China. The estimated incidence of hyperphenylalaninemia was 1 in 29 542 live births.

CONCLUSIONSOur data indicate that it is indisputable for the introduction of expanded newborn screening program in Hong Kong. Since Hong Kong is a metropolitan city, a comprehensive expanded newborn screening program and referral system should be available to serve the neonates born in the area.

Acids ; urine ; Amino Acids ; blood ; Carnitine ; analogs & derivatives ; blood ; Hong Kong ; epidemiology ; Humans ; Infant, Newborn ; Metabolism, Inborn Errors ; blood ; diagnosis ; epidemiology ; urine ; Neonatal Screening ; methods ; Tandem Mass Spectrometry

BACKGROUNDAcute gout is an intensely painful, inflammatory arthritis. Although the non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for this condition, the efficacy is based on only a few studies, particularly in China. We tried to assess the safety and efficacy of etoricoxib in the treatment of acute gouty arthritis in China.

METHODSA randomized, double-blind, active comparator study was conducted at 10 sites in China. Patients (n = 178; ≥ 18 years of age) with acute gouty attack (< 48 hours) were treated for 5 days with etoricoxib (120 mg/d; n = 89) or indometacin (75 mg twice daily; n = 89). The primary efficacy end point was self-assessed pain in the affected joint (0-4 point Likert scale) from days 2 - 5. Secondary end points included investigator assessments of tenderness and swelling, patient/ investigator global assessments of response to therapy, and patients discontinuing treatment. Safety was assessed by adverse events (AEs).

RESULTSEtoricoxib and indometacin had comparable primary and secondary end points. Mean change difference from baseline from days 2 - 5 was 0.03 (95% confidence interval (CI) -0.19 to 0.25; P = 0.6364), which fell within the prespecified comparative bounds of -0.5 to 0.5. No severe AEs were associated with etoricoxib use. Non-severe AEs were mainly digestive and general, and most (73.7%) were mild, although they caused withdrawal of two subjects in the etoricoxib group, due to bilateral renal calculi and uronephrosis of the left kidney (unrelated to etoricoxib) and fever and chills (potentially etoricoxib-related). Overall, AEs were similar, although the absolute number of AEs in the etoricoxib group (n = 31) was less than the indometacin group (n = 34).

CONCLUSIONSEtoricoxib (120 mg once daily) is effective in treating acute gout, is generally safe and well-tolerated, and is comparable in efficacy to indometacin (75 mg twice daily).

Adult ; Aged ; Arthritis, Gouty ; drug therapy ; Cyclooxygenase Inhibitors ; adverse effects ; therapeutic use ; Double-Blind Method ; Female ; Humans ; Indomethacin ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Pyridines ; adverse effects ; therapeutic use ; Sulfones ; adverse effects ; therapeutic use

BACKGROUNDVon Hippel-Lindau (VHL) syndrome is an autosomal dominant familial cancer syndrome predisposing the affected individuals to multiple tumours in various organs. The genetic basis of VHL in Southern Chinese is largely unknown. In this study, we characterized the mutation spectrum of VHL in nine unrelated Southern Chinese families.

METHODSNine probands with clinical features of VHL, two symptomatic and eight asymptomatic family members were included in this study. Prenatal diagnosis was performed twice for one proband. Two probands had only isolated bilateral phaeochromocytoma. The VHL gene was screened for mutations by polymerase chain reaction, direct sequencing and multiplex ligation-dependent probe amplification (MLPA).

RESULTSThe nine probands and the two symptomatic family members carried heterozygous germline mutations. Eight different VHL mutations were identified in the nine probands. One splicing mutation, NM_000551.2: c.463+1G > T, was novel. The other seven VHL mutations, c.233A > G [p.Asn78Ser], c.239G > T [p.Ser80Ile], c.319C > G [p.Arg107Gly], c.481C > T [p.Arg161X], c.482G > A [p.Arg161Gln], c.499C > T [p.Arg167Trp] and an exon 2 deletion, had been previously reported. Three asymptomatic family members were positive for the mutation and the other five tested negative. In prenatal diagnosis, the fetuses were positive for the mutation.

CONCLUSIONSGenetic analysis could accurately confirm VHL syndrome in patients with isolated tumours such as sporadic phaeochromocytoma or epididymal papillary cystadenoma. Mutation detection in asymptomatic family members allows regular tumour surveillance and early intervention to improve their prognosis. DNA-based diagnosis can have an important impact on clinical management for VHL families.

Asian Continental Ancestry Group ; DNA Mutational Analysis ; Humans ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Von Hippel-Lindau Tumor Suppressor Protein ; genetics ; von Hippel-Lindau Disease ; genetics