Objective To evaluate the efficacy and safety of single forcep endoscopic purse-string suture closing the wound of cardia and gastric fundus after endoscopic full-thickness resection (EFTR) for patients with submucosal tumor (SMT).Methods The clinical data of 32 patients with wound in the cardia and gastric fundus after EFTR for SMT undergoing single forcep endoscopic purse-string suture in Endoscopy Center of Renmin Hospital of Wuhan University from January 2015 to January 2016 were collected.Completion of operation, postoperative complication and follow-up results of these patients were retrospectively analyzed.Results All of the patients successfully received EFTR and purse-string suture.The maximal diameter of tumors was 1-4 cm.The suture time was 10-15 min, and postoperative hospital stay was 5-10 d.Low fever and upper abdominal pain were found in 13 and 20 cases respectively, and all cases were alleviated or restored after conservative treatment.All patients underwent gastroscopy during follow-up of 1 month, and titanium clip and nylon rope were found on the wound surface in 29 cases (90.6%).Three months after operation, 28 patients underwent gastroscopy, and titanium clip but no nylon rope was detected in 15 cases (46.9%).Conclusion Single forcep endoscopic purse-string suture can effectively treat the postoperative wound in the cardia and gastric fundus of patients with submucosal tumors after EFTR.

Objective To evaluate the curative effect of laparoscopic myomectomy combined with preoperative gonadotropin releasing hormone agonists (GnRH-a) in treating myoma patients with uterus volume large than 12 weeks of pregnancy size. Methods 46 patients with uterine volume over 12 gestational weeks from August 2009 to August 2016 were selected as research objects. Leuprolide was injected subcutaneously for three to six times, and then laparoscopic myomectomy was performed one month later. The changes of volumes in uterus and myoma before and after medication were observed as well as the changes of hemoglobin. And postoperative recurrence of uterus myoma was followed up. Results The average volume of the uterus in the 46 patients, detected by B ultrasound, before GnRH-a treatment was (705.47 ± 282.37) cm3, and the average volume of the uterus after GnRH-a treatment was (331.95 ± 84.53) cm3, which was shortened by 59.35%, with significant difference (P < 0.05). The volume of uterus myoma was (237.59 ± 138.46) cm3 before GnRH-a treatment and (81.59 ± 46.44) cm3 after GnRH-a treatment, shortened by 65.66%, with significant difference (P < 0.05). The hemoglobin value was (97.80 ± 20.19) g/L before GnRH-a and (119.63 ± 12.06) g/L after GnRH-a treatment, with significant difference (P < 0.05). Follow-up for 3 weeks to 5 years, the surgeries were accomplished successfully, and no case was transferred to laparotomy. Conclusion Preoperative GnRH-a could shorten volume of uterus myoma, increase hemoglobin value and ensure performance of laparoscopic myomectomy for myoma patients with uterus volume large than 12 weeks of pregnancy size.

Objective To analyze the dynamic changes in blood lipids and ATP-binding cassette transporter A1 (ABCA1) in peripheral blood monocytes of the patients with type 2 diabetes, and explore the correlations between ABCA1 expression and blood lipids levels and glycometabolism. Methods Human monocytes were isolated from the patients with type 2 diabetes (n=40) and from the healthy individuals (n=40) serve as normal control. ABCA1 was labeled by immune reaction PE fluorescence, then the changes in ABCA1 expression before and after being incubated with the ox-LDL were investigated by flow cytometer. The blood lipid levels, fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) levels in the patients of type 2 diabetes group were determined, and the correlations between ABCA1 and age, blood lipid, and glycometabolic levels were analyzed. Results Plasma levels of triglyceride, non-high density lipoprotein cholesterol (NHDL-C) [low density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C)] in the patients of type 2 diabetes group were significantly higher than that in control group (P

Objective To investigate the clinical features and treatment of Kaposi's varicelliform eruption. Methods Clinical data on 24 cases of Kaposi's varicelliform eruption were retrospectively analyzed.Results All the 24 patients were accompanied by different underlying skin diseases, including eczema in 17 cases and atopic dermatitis in 7 cases. PCR of vesicle fluid was positive for herpes simplex virus type 1 (HSV 1 ) in 16 (66.67%) patients, and culture of vesicle fluid or lesional exudates grew Staphylococcus aureus in 12 (50%) patients. Conclusion Infants with atopic dermatitis or eczema are rather susceptible to Kaposi's varicelliform eruption, which may be partly caused by herpes simplex virus infection.

Objective To analyze the laws of acupoint selection of acupuncture for generalized anxiety disorder (GAD); To provide references for clinical treatment.Methods Computers were used to search articles about acupuncture for GAD from China National Knowledge Infrastructure (CNKI), Wanfang Database Resource System, Chinese Scientific Journal Database (VIP database) and Chinese BioMedical Literature (CBM) from their respective founding dates to Dec. 31, 2015. The corresponding database was established with NoteExpress2, and the laws of acupoints were analyzed.Results Totally 41 articles were included, including 56 acupuncture prescriptions, involving 50 acupoints in 14 meridians. The frequency for acupoint selection was 287 times. There were 49 main acupoints (225 times of acupoint selection, accounting for 98.0%) and 23 matching acupoints (62 times of acupoint selection, accounting for 46.0%) in the treatment of GAD. Main acupoints with high frequency were Baihui (GV20), Shenmen (HT07), Neiguan (PC06), Sanyinjiao (SP06) and Yintang (GV29). Matching acupoints with high frequency were Zusanli (ST36), Taichong (LR3), Neiguan (PC06), Shenmen (HT07), and Fenglong (ST40). Selecting acupoints along meridian mainly depended on Governor Meridian, Taiyang Bladder Meridian of Foot, Shaoyin Heart Meridian of Hand and Jueyin Pericardium Meridian of Hand.ConclusionPrinciples of acupuncture for GAD is treatment determination from heart and brain, emphasizing syndrome differentiation and identification of diseases, and the clinic mainly adopts acupoints along meridian with symptomatic acupoints treatment.

OBJECTIVE:To observe the clinical efficacy and safety of flunarizine combined with salvianolate in the treatment of acute migraine. METHODS:A total of 72 patients with acute migraine were randomly divided into control group(36 cases)and observation group (36 cases). Based on routine treatment,control group was given Flunarizine hydrochloride capsules orally,10 mg for 65 year-old and below once a day,5 mg for more than 65 year-old once a day. Observation group was additionally given Flunarizine hydrochloride for injection 200 mg intravenously,once a day,on the basis of control group. Both groups were treated contineously till cured or for 2 weeks. Clinical efficacy,onset time,recovery time,VAS score,frequency and duration of head-ache attack,ADR were observed in 2 groups. RESULTS:In the course of treatment,the two groups did not terminate and fall off, and all of them completed the treatment. The total response rate(97.22%)of observation group was significantly higher than that (86.11%)of control group;onset time and recovery time of observation group were both shorter than those of control group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in VAS score,frequency or duration of headache attack between 2 groups (P>0.05). After treatment,VAS score,frequency and duration of headache attack in 2 groups were all significantly lower than before,and the observation group was significantly lower than the control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLU-SIONS:Based on routine treatment,flunarizine hydrochloride capsules combined with Salvianolate injection show significant effica-cy for acute migraine with good safety.

Objective To explore the correlation of traditional Chinese medical syndrome elements with plasma connective tissue growth factor ( CTGF) and platelet-derived growth factor ( PDGF) in early liver cirrhosis induced by type B hepatitis. Methods The distribution of traditional Chinese medical syndrome elements in early liver cirrhosis induced by type B hepatitis was analyzed, plasma contents of CTGF and PDGF were detected by enzyme-linked immunosorbent assay ( ELISA) , and the correlation of syndrome elements with CTGF and PDGF was discriminated. Results ( 1) The distribution of traditional Chinese medical syndrome elements in early liver cirrhosis induced by type B hepatitis showed as follows: the syndrome elements involved the viscera of liver and spleen, and the pathogenesis was characterized as dampness, heat, qi stagnation, and yin deficiency. ( 2) CTGF was closely related with spleen, gallbladder and dampness, with OR value being 1.598, 1.567, 2.797, respectively. PDGF was closely related with heat, with OR value being 1.134. Conclusion Early liver cirrhosis induced by type B hepatitis mainly affects the viscera of liver and spleen, the pathogenesis is characterized by dampness, heat, qi stagnation, and yin deficiency. The patients with higher CTGF are apt to show the pathological changes of spleen, gallbladder, dampness, and have the syndrome el-ements of spleen, gallbladder, dampness. The patients with higher PDGF are apt to show the pathological changes of heat, and have the syndrome element of heat.

Objective To investigate the image quality and radiation dose of 640-slice CT coronary arteriography(CTCA) with adaptive iterative dose reduction three-dimensional (AIDR3D)reconstrucction algoritym.Methods 640-slice CTCA with auto-matic exposure was performed on 84 consecutive patients.The original image data were reconstructed with AIDR3D and the filtered back-projection (FBP)algorithms at the image postprocessing workstation.Two experienced radiologists without knowing clinical information and reconstruction algorithms independently measured and calculated the image noise,signal-to-noise ratio and contrast-to-noise ratio with AIDR3D and FBP reconstruction algorithms.The qualitative image quality was assessed by using the 4-point scale.The radiation dose was calculated based on dose-length product exported on CT scanner.The quantitative and qualitative im-age quality with two kinds of reconstruction algorithm was analyzed statistically.Results The CTCA image noise was (27.20± 4.40)HU with AIDR3D and (60.00±12.40)HU with FBP,which with AIDR3D was decreased by 46.10% than that with FBP;the signal-to-noise ratio was 21.10 ± 5.10 with AIDR3D and 11.40 ± 2.80 with FBP,which with AIDR3D was increased by 84.70% than that with FBP;the contrast-to-noise ratio was 24.70±5.10 with AIDR3D and 13.50±3.20 with FBP,which with AIDR3D was raised by 82.20% than that with FBP,the differences in 3 indexes between the two kinds of reconstruction algorithm were statistically significant(P < 0.05 ).The CTCA qualitative image quality scores of proximal,middle and distal parts with AIDR3D were (3.90±0.30),(3.70±0.50)and (3.60±0.60)respectively,which all were higher than (2.60±0.60),(2.30± 0.60)and (2.10±0.70)with FBP respectively,the differences in 3 items between 2 kinds of algorithm had statistical significance (P <0.05).The total segments which could be used to diagnose the CTCA images with AIDR3D and FBP algorithms were 1 216 segments (96.50%)and 504 segments (40.00%),respectively,the difference had statistical significance(P <0.05).The mean ef-fective radiation dose was (2.10±1.00)mSv.Conclusion 640-slice CTCA with AIDR3D reconstruction algorithm not only signifi-cantly reduces the image noise than the conventional FBP algorithm,improves the quantitative and qualitative image quality,but also decreases the effective radiation dose.

Objective To investigate the effect of 1?,25-dihy-droxyvitamin D3 (1?,25(OH)2D3) on the expression of receptor activator of NF-?B ligand (RANKL),osteoprotegerin (OPG) and RANKL mRNA,OPG mRNA,of rat osteobalsts (OB). Method The expression of RANKL and OPG was detected by the method of Immunohistochemistry and ELISA. RANKL mRNA and OPG mRNA were determined through FQ-PCR. Results Compared with the control group and the group with 1 nmol/L 1?,25(OH)2D3,10 and 100 nmol/L 1?,25(OH)2D3 can significantly induce the expression of RANKL and RANKL mRNA. 1,10 nmol/L 1?,25(OH)2D3 can stimulate the expression of OPG and OPG mRNA significantly,while 100 nmol/L 1?,25(OH)2D3 can inhibit the expression of OPG mRNA significantly. There were no difference in the rate of RANKL/OPG and RANKL mRNA/OPG mRNA between the control group and the group with 1 nmol/L 1?,25(OH)2D3,however the rate of RANKL/OPG and RANKL mRNA/OPG mRNA in the group with 10,100 nmol/L were higher than the control group and the group with 1 nmol/L 1?,25(OH)2D3. Conclusion Lower dosage of 1?,25(OH)2D3 (1 nmol/L) had no significant effect on bone turnover,but higher dosage of 1?,25(OH)2D3 (10,100 nmol/L) can enhance bone turnover through facilitating the formation and activity of osteoclasts via enhancing RANKL mRNA/OPG mRNA and RANKL/OPG..

Objective To explore the associations of depressive symptoms with functional status and frailty in elderly outpatients.Methods A total of 297 geriatric outpatients(aged 65 years and over) from Zhejiang Hospital were recruited in the cross-sectional study from January 2014 to December 2015.We gathered general information,and evaluated depressive symptoms by Geriatric Depression Scale-15 (GDS-15),cognitive function by mini-mental state examination(M MSE),frailty by clinical frailty scale(CFS),activities of daily living (ADL)by Barthel index,instrumental activities of daily living (IADL),balance,POMA and gait by Tinetti-performance oriented mobility assessment (Tinetti-POMA),grip strength and 4m gait speed by 4-meter walk gait speed test.According to the GDS-15 scores,297 geriatric outpatients were divided into a depression symptom group(n=35,GDS-15 ≥6)and a nomdepressive symptom group(n=262,GDS-15＜6).The frailty and functional status were compared between two groups by SPSS 23.0.Results As compared with non-depressive symptoms,the depressive symptoms group had higher clinical frailty scale(CFS),lower body mass index(BMI),lower cognitive function and poorer grip strength and balance(all P＜0.05).There were significantly negative correlations of Geriatric Depression Scale-15 (GDS-15) with ADL,IADL,gait,balance,POMA and grip strength(r=-0.165、-0.154、-0.216、-0.291、-0.305、-0.314,All P＜ 0.05),while there were significantly positive correlations with CFS score,gait speed(r=0.256、0.198,both P＜0.05).The more severe the frailty was,the higher the risk of depressive symptoms was(OR=3.650,95％ CI 1.611-8.271).Conclusions The cognitive and physical functions in the elderly with depression symptoms are poorer as compared with the elderly without depression symptoms.Elderly outpatients with more severe frailty have a higher risk for depressive symptoms.