Objective To investigate the early diagnosis of vitiligo and its differential diagnosis from other depigmentated diseases using polarized light dermoscopy(PD)imaging analysis.Methods Patients with localized depigmented macules were enrolled into this study.PD was used to observe the micromorphology,feature and color of skin lesions.Histopathology was performed to confirm the diagnosis of all cases except for those of pityriasis versicolor which were confirmed by clinical and laboratory examination.Results Of the 176 patients.97 were diagnosed as vitiligo.Residual perifollicular pigmentation Was observed in 91.94%(57/62)of patients with progressing vitiligo and 62.86%(22/35)of those with stable vitiligo,with significant difference between the two groups of patients(P<0.05).However.residual perifollicular pigmentation was absent in the 79 non-vitiligo depigrnented cases.The presence of telangiectasia,early reservoirs of pigmentation and perilesional hyperpigmentation were related to the stage of vitiligo and treatment history of patients.Conclusions PD,which efficiently eliminates the interference of reflected light on skin lesions of vililigo,is an imaging technique that allows for the visualization of minor structures and features of the skin lesions that are indiscernible to naked eyes.In a nutshell,the application of PD has offered references to the early diagnosis of vitiligo and its differential diagnosis from other depigmentation diseases.

Objective To investigate the value of image analysis technology of polari-light dermoscopy (PD) in diagnosing head and face tumors. Methods We randomly collected the head and face tumors from the patients in this hospital, and then diagnosed them with naked eyes and PD, respectively. After making sure the diagnosis by histopathology, we analyzed the results retrospectively. Results We summarized the diagnostic signs of 211 head and face tumors on dermoscopy, which shown a great specificity. Its diagnosis rate reached to 92.89 %, obviously higher than that (69.67 %)with naked eyes. Due to clinical misdiagnosis and erroneous treatment, the recurrence rate of skin lesions was 19.91 %. The top 3 of head and face tumors, in turn, was seborrheic keratosis, melanocytic tumor and basal cell carcinoma. Conclusions PD is a non-invasive image analysis technology, which is especially applicable to the early diagnosis of head and face tumors. It can make sense in decreasing blind biopsy, directing surgical excision areas effectively, and selecting reasonable remedy. It also has great significance in the recovery and beauty of skin lesions.

1:16) of the relative serum antibody has been observed in 80%, while none of this high level was observed in patients with Echovirus-25 and adenovirus dermatitis (

OBJECTIVETo observe the effect of resolving phlegm method (RPM) on fibrinolytic status in non-alcoholic steatohepatitis (NASH) patients of phlegm blood-stasis (PBS) syndrome type.

METHODSSixty-two patients were randomly assigned to 2 groups, namely the treated group (n = 34) treated with Chinese herbs for resolving phlegm and dampness, smoothing liver and gallbladder, promoting blood circulation and removing blood stasis (composition: Indigo Naturalis 10 g, Alumen 3 g, Semen Cassiae 15 g, Fructus Crataegi 15 g, vinegar prepared Radix Bupleuri 10 g, Radix Curcumae 10 g, Radix Salviae Miltiorrhizae 12 g, Herba Lycopi 12 g, talc 12 g and Radix Glycyrrhizae 2 g), one dose twice per day orally, and the control group (n = 28) with ursodeoxycholic acid tablet (UAT) 150 mg three times per day. The treatment course for both groups was 12 weeks. Liver function (ALT, AST, ALP), insulin resistance (IR) index represented by homeostasis model-IR (HOMA-IR) and insulin (Ins), levels of tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1), as well as main symptoms and physical signs were assessed before and after treatment.

RESULTS(1) Compared with those before treatment, levels of ALT, AST, HOMA-IR, t-PA, PAl-1 and main symptoms were all improved in the treated group (P < 0.05 or P < 0.01); (2) There was significant difference in ALP, HOMA-IR, t-PA and PAI-1 between the treated group and the control group (P < 0.05 or P < 0.01); (3) The improvement in liver function related indexes in the control group was mainly the level of ALT, t-PA (P < 0.01), and also shown on HOMA-IR, Ins and PAI-1.

CONCLUSIONRPM could effectively improve liver function and fibrinolytic status. Its effect was better than that of UAT.

Adult ; Aged ; Blood Glucose ; metabolism ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Fatty Liver ; blood ; diagnosis ; drug therapy ; Female ; Humans ; Insulin ; blood ; Liver ; drug effects ; pathology ; physiopathology ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Phytotherapy ; Plasminogen Activator Inhibitor 1 ; metabolism ; Syndrome ; Tissue Plasminogen Activator ; metabolism

OBJECTIVETo investigate the clinical effect of fast-track surgery combined with Chinese medicine treatment in devascularization operation for cirrhotic esophageal varices.

METHODSSeventy-two patients with cirrhotic esophageal varices were selected from January 2009 to June 2013, and randomly assigned to a conventional group and a fast-track group (fast-track surgery combined with Chinese medicine treatment) using a randomized digital table, 36 cases in each group. Operation and anesthesia recovery time, postoperative hospitalization and quality of life were recorded and compared between groups during the perioperative period.

RESULTSCompared with the conventional group, the fast-track group had longer operation time (253.6±46.4 min vs. 220.6±51.0 min) and anesthesia recovery time (50.5±15.9 min vs. 23.5±9.6 min; P<0.01); less bleeding (311.3±46.8 mL vs. 356.2±57.5 mL; P<0.01) and less transfusion (1932.3±106.9 mL vs. 2045.6±115.4 mL; P<0.01); as well as faster recovery of gastrointestinal function, shorter postoperative hospitalization and higher quality of life. There were no serious postoperative complications and no further bleeding occurred.

CONCLUSIONFast-track surgery combined with Chinese medicine treatment is a safe and feasible approach to accelerate the recovery of patients with cirrhotic portal hypertension in perioperative period of devascularization operation.

Adult ; Aged ; Anesthesia Recovery Period ; Blood Loss, Surgical ; Blood Transfusion ; Chronic Disease ; Esophageal and Gastric Varices ; surgery ; therapy ; Female ; Humans ; Length of Stay ; Liver Cirrhosis ; complications ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Operative Time ; Postoperative Complications ; Postoperative Period ; Quality of Life ; Splenectomy

OBJECTIVE： To systematically evaluate the efficacy and safety of hydrotalcite combined with omeprazole for gastric ulcer， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Embase， Medline， the Cochrane library， CNKI， VIP and Wanfang database， randomized controlled trials （RCTs） about hydrotalcite combined with omeprazole （trial group） versus omeprazole alone （control group） for gastric ulcer during the database establishment to Aug. 2018. After data extraction of included literatures met inclusion criteria， and quality evaluation with Cochrane evaluator manual 5.0.1， Meta-analysis was performed for response rate， the incidence of ADR， recurrence rate of gastric ulcer bleeding， needed time of clinical symptom improvement and hospitalization stays by using Rev Man 5.3 statistical software. RESULTS： A total of 16 RCTs， involving 1 802 patients were included. The results of Meta-analysis showed that response rate [RR＝1.24， 95％CI（1.19，1.29）， P＜0.001] of trial group was significantly higher than that of control group； recurrence rate of gastric ulcer [RR＝0.27，95％CI（0.17，0.45），P＜0.001]， clinical symptom improvement time [MD＝－2.04，95％CI（－2.25，       －1.83），P＜0.001] and hospitalization time [MD＝－4.25，95％CI（－4.55，－3.95），P＜0.001] of trial group were significantly lower or shorter than those of control group， with statistical significance. There was no statistical significance in the incidence of ADR [RR＝0.68，95％CI（0.46，1.02），P＝0.06] between 2 groups. CONCLUSIONS： Compared with omeprazole alone， hydrotalcite combined with omeprazole for gastric ulcer can obviously increase the clinical response rate， decrease the recurrence rate of gastric ulcer and shorten the needed time of clinical symptom improvement and hospitalization time， but do not increase the incidence of ADR.

OBJECTIVE： To systematically review therapeutic efficacy and safety of mirtazapine combined with selective calcium channel blocker （SCCB） in the treatment of irritable bowel syndrome （IBS）， and provide evidence-based reference for clinical medication. METHODS： Retrieved from the Cochrane Library， PubMed， Embase， Medline， CNKI， VIP and Wanfang database， randomized controlled trials （RCTs） about mirtazapine combined with SCCB （trial group） versus SCCB （control group） for IBS were collected. After literature screening and data extraction， quality evaluation was performed by using Cochrane system evaluator manual 5.1.0 recommend bias risk evaluation tool. Meta-analysis was performed by using Stata 14.0 software. RESULTS： A total of 14 RCTs involving 1 005 patients were included. The results of Meta-analysis showed that the total response rate [RR＝1.34，95％CI（1.25，1.44），P＜0.001]，neuropeptide-Y level after treatment [SMD＝0.77，95％CI（0.49，1.05），P＜0.001]， response rate of abdominal pain therapy [RR＝1.32，95％CI（1.06，1.66），P＝0.014] and response rate of treatment for abnormal stool characteristics [RR＝1.75，95％CI（1.36，2.27）， P＜0.001] were significantly higher than control group； the scores of depression scale after treatment [SMD＝－1.87， 95％CI （－2.35， －1.39）， P＜0.001]， anxiety scale after treatment [SMD＝－2.25， 95％CI （－3.35， －1.15）， P＜0.001]， abdominal pain symptom score after treatment [SMD＝－7.41， 95％CI  （－8.30，－6.51）， P＜0.001]， diarrhea symptom score after treatment [SMD＝－6.39， 95％CI （－7.96，－4.81）， P＜0.001] were significantly lower than those of the control group. There were no statistical significance in response rate of abdominal distension therapy [RR＝1.07，95％CI（0.90，1.28），P＝0.421] and response rate of abnormal defecation therapy [RR＝1.05，95％CI（0.88，1.26），P＝0.588]， the incidence of abdominal pain [RR＝0.45，95％CI（0.11，1.97）， P＝0.291] and exhaustion [RR＝5.00，95％CI（0.60，41.79），P＝0.137] between 2 groups. CONCLUSIONS： Mirtazapine combined with SCCB can significantly improve therapeutic efficacy of IBS patients， promote clinical symptoms， but do not increase the occurrence of ADR as abdominal pain and exhaustion.

INTRODUCTIONHead and neck squamous cell carcinoma (HNSCC) is a common cancer worldwide and has a poor prognosis. A biomarker predicting the clinical outcome of HNSCC patients could be useful in guiding treatment planning. Overexpression of the T lymphoma invasion and metastasis 1 (Tiam1) protein has been implicated in the migration and invasion of neoplasms. However, its role in HNSCC progression needs to be further validated. We detected the expression of Tiam1 in normal and tumor tissues and determined its association with clinical outcomes in patients with HNSCC.

METHODSWe measured the expression of Tiam1 in normal and cancerous tissue samples from the patients with HNSCC treated at Sun Yat-sen University Cancer Center between 2001 and 2008. The Tiam1 expression was scored from 0 to 12 based on the percentage of positively stained cells and the staining intensity. We then determined the diagnostic performance of this score in predicting overall survival (OS) and disease-free survival (DFS).

RESULTSOf the 194 evaluable patients, those with advanced disease, lymph node metastasis at diagnosis, and recurrence or metastasis during follow-up had a higher tendency of having high Tiam1 expression as compared with their counterparts (P < 0.05). The proportion of samples with high Tiam1 expression was also higher in cancerous tissues than in non-cancerous tissues (57.7% vs. 13.9%, P < 0.001). Cox proportional hazards regression analysis revealed that Tiam1 expression scores of 5 and greater independently predicted short OS and DFS.

CONCLUSIONThe Tiam1 expression is shown as a promising biomarker of clinical outcomes in patients with HNSCC and should be evaluated in prospective trials.

Adult ; Aged ; Biomarkers, Tumor ; metabolism ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; secondary ; Disease Progression ; Female ; Follow-Up Studies ; Guanine Nucleotide Exchange Factors ; metabolism ; Head and Neck Neoplasms ; diagnosis ; pathology ; secondary ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Proteins ; metabolism ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Retrospective Studies ; Survival Analysis ; T-Lymphoma Invasion and Metastasis-inducing Protein 1

OBJECTIVE: To assess the effect and safety of Hydroxysafflor Yellow A for Injection (HSYAI) in treating patients with acute ischemic stroke (AIS) and blood stasis syndrome (BSS). METHODS: A multicenter, randomized, double-blind, multiple-dose, active-controlled phase II trial was conducted at 9 centers in China from July 2013 to September 2015. Patients with moderate or severe AIS and BSS were randomly assigned to low-, medium-, high-dose HSYAI groups (25, 50 and 70 mg/d HSYAI by intravenous infusion, respectively), and a control group (Dengzhan Xixin Injection (, DZXXI) 30 mL/d by intravenous infusion), for 14 consecutive days. The primary outcome was the Modified Rankin Scale (mRS) score ⩽1 at days 90 after treatment. The secondary outcomes included the National Institute of Health Stroke Scale (NIHSS) score ⩽1, Barthel Index (BI) score ⩾95, and BSS score reduced ⩾30% from baseline at days 14, 30, 60, and 90 after treatment. The safety outcomes included any adverse events during 90 days after treatment. RESULTS: Of the 266 patients included in the effectiveness analysis, 66, 67, 65 and 68 cases were in the low-, medium-, and high-dose HSYAI and control groups, respectively. The proportions of patients in the medium- and high-dose HSYAI groups with mRS score ⩽1 at days 90 after treatment were significantly larger than the control group (P<0.05). The incidences of favorable outcomes of NIHSS and BI at days 90 after treatment as well as satisfactory improvement of BSS at days 30 and 60 after treatment in the medium- and high-dose HSYAI groups were all significantly higher than the control group (P<0.05). No significant difference was reported among the 4 groups in any specific adverse events (P>0.05). CONCLUSIONS HSYAI was safe and well-tolerated at all doses for treating AIS patients with BSS. The medium (50 mg/d) or high dose (75 mg/d) might be the optimal dose for a phase III trial. (Registration No. ChiCTR-2000029608).

ObjectiveTo investigate the role and possible mechanism of action of rhubarb decoction （RD） retention enema in improving inflammatory damage of brain tissue in a rat model of mild hepatic encephalopathy （MHE）. MethodsA total of 60 male Sprague-Dawley rats were divided into blank group （CON group with 6 rats） and chronic liver cirrhosis modeling group with 54 rats using the complete randomization method. After 12 weeks， 40 rats with successful modeling which were confirmed to meet the requirements for MHE model by the Morris water maze test were randomly divided into model group （MOD group）， lactulose group （LT group）， low-dose RD group （RD1 group）， middle-dose RD group （RD2 group）， and high-dose RD group （RD3 group）， with 8 rats in each group. The rats in the CON group and the MOD group were given retention enema with 2 mL of normal saline once a day； the rats in the LT group were given retention enema with 2 mL of lactulose at a dose of 22.5% once a day； the rats in the RD1， RD2， and RD3 groups were given retention enema with 2 mL RD at a dose of 2.5， 5.0， and 7.5 g/kg， respectively， once a day. After 10 days of treatment， the Morris water maze test was performed to analyze the spatial learning and memory abilities of rats. The rats were analyzed from the following aspects： behavioral status； the serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， interleukin-1β （IL-1β）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） and the level of blood ammonia； pathological changes of liver tissue and brain tissue； the mRNA and protein expression levels of phosphatidylinositol 3-kinase （PI3K）， protein kinase B （AKT）， and mammalian target of rapamycin （mTOR） in brain tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the MOD group， the RD1， RD2， and RD3 groups had a significantly shorter escape latency （all P<0.01）， significant reductions in the levels of ALT， AST， IL-1β， IL-6， TNF-α， and blood ammonia （all P<0.05）， significant alleviation of the degeneration， necrosis， and inflammation of hepatocytes and brain cells， and significant reductions in the mRNA and protein expression levels of PI3K， AKT， and mTOR in brain tissue （all P<0.05）， and the RD3 group had a better treatment outcome than the RD1 and RD2 groups. ConclusionRetention enema with RD can improve cognitive function and inflammatory damage of brain tissue in MHE rats， possibly by regulating the PI3K/AKT/mTOR signaling pathway.