BACKGROUND: Glucose metabolism disturbance, one of clozapine's adverse effects, has received increasing attention from endocrinologists. Insulin resistance is believed to be associated with clozapine-induced glucose metabolism disturbance. Does it have direct effects on secretion function of islets?OBJECTIVE: To investigate the effects of different concentrations of clozapine on the secretion function of pancreatic islets in vitro.DESIGN: A completely randomized controlled design for the experimental study.SETTING: Department ofPsychiatry, People's Hospital of Wuhan University.MATERIALS: The experiment was conducted in the Laboratory Center of Stomatology Hospital of Wuhan University from September 2003 to January2004. Three healthy male Wistar rats of clean grade were used.METHODS: [1] Classical collagenase digestion method was used to isolate and purify the rat islets of Langerhans. [2] Hank's solution containing 2 g/L bovine serum albumin and 3.3 mmol/L glucose was added for preincubation for 30 minutes. The supernatant was removed. The wells were divided into five groups with 12 wells in each group. The control group was added with 1 g/L dimethyl sulphoxide (DMSO) and 3.3 mmol/L or 16.7 mmol/L glucose, 1 mL per well. The four experimental groups were added with 1 mL 0.2 μmol/L, 1 μmol/L, 5 μmol/L, or 10 μmol/L clozapine apart from the above DMSO and glucose. Six wells in each group were incubated for 1 hour, and another six wells were incubated for 4hours. The supernatants of the different groups were collected and stored at-20℃ in the refrigerator for later testing. The above procedures were repeated three times. The insulin released into the medium supernatant was examined by radioimmunoassay. [3] One-way ANOVA was used to compare the differences between the experimental groups and control group; LSD-t test was used for multiple comparison.MAIN OUTCOME MEASURES: The level of insulin secretion in the supernatants in culture solution containing 3.3 mmol/L or 16.7 mmol/L glucose which was incubated for 1 hour or 4 hours.RESULTS: [1] At 3.3 mmol/L glucose, no difference in insulin secretion was found between the four clozapine groups and control group after 1-hour incubation (P ＞ 0.05). After 4-hour incubation, the level of insulin in clozapine groups decreased significantly [(0.92±0.4), (1.02±0.3),(1.06±0.4), (0.74±0.2), (1.66±0.4) mU/IEQ, P ＜ 0.05]. There was no significant difference in the volume of insulin among the four clozapine groups with different concentrations (P ＞ 0.05). [2] At 16.7 mmol/L glucose, the level of insulin at the four concentrations of clozapine did not differ from that of control group either after 1 hour or 4 hours of incubation (P ＞ 0.05).CONCLUSION: Clozapine inhibits basal insulin secretion, but the effect is not correlated with its dosage.

OBJECTIVE:To promote clinical rational drug use (RDU). METHODS:2000 prescriptions before intervention (from Jan. to Apr. in 2003) and another 2000 after intervention (from Jan. to Apr. in 2006) were randomly selected for a statistical analysis in accordance with the international RDU indicators of WHO/INRUD. RESULTS:Regarding the prescription indicators,the average number of drugs per prescription was 3.88 kinds before intervention versus 1.97 after intervention; the proportion of patients treated with antibiotics was 38.40% before intervention versus 24.05% after intervention; the proportion of injections was 21.75% before intervention versus 12.75% after intervention. In terms of patient care indicators,the average consultation time was 9.5 minutes and the average dispensing time was 23 seconds,and the percentage of drugs with integral labeling was as high as 100%. CONCLUSION:Most of the RDU indictors in our hospital were satisfactory; however,the average cost per prescription was still on the high side,which calls for further intervention.

Glomus Tumor ; diagnosis ; etiology ; Humans ; Neoplasms, Connective Tissue ; complications ; Osteomalacia

OBJECTIVE: To investigate curative effect and importance of radiofrequency thermocoagulation onsemilunar ganglion of aged patients with recurrent trigeminal neuralgia. METHOD: 112 cases with recurrent trigeminal neuralgia were performed with radiofrequency thermocoagulation on semilunar ganglion by puncture through skin under local anesthesia. RESULT: The maintaining effective duration in 112 cases was 7.3 ± 1.3 years after primary therapy. After the first thermocoagulation, 89.28% (100/112) patients got the relief from pain immediately, 8 (7.14%) cases also recieved the same effect after twice treatment. However two cases (2.6%) had no effects. The total effective rate was 98.21%. During five follow-up years, VAS scores, dose of carbamazepine and satisfaction were better than those before the treatment. The effective rate was still over 57.5% within three years after the treatment. The recurrent risk increased obviously from 40 months after the treatment by Kaplan-Meier method. CONCLUSION Semilunar ganglion of radiofrequency thermocoagulation was an ideal option for old-age patients with trigeminal neuralgia. It can be performed repeatedly.
Aged ; Electrocoagulation ; Humans ; Recurrence ; Treatment Outcome ; Trigeminal Ganglion ; surgery ; Trigeminal Neuralgia ; surgery

[Objective] To standardize integrated traditional and western treatment programs of lower urinary infection and evaluate its effect and to insure the safety. [Methods] TCM syndrome type of lower urinary tract infection is divided into Xuelin type, gaolin type, laolin type, qilin type, relin type. Each type col ects separately 60 patients. Every 60 patients are randomly divided into experimental and control groups.The way to treat the patients for the con-trol group must be in accordance with the norms of western medicine treatment of anti-infection. By contrast, the way that the patients from the experi-mental group should be based on the western medicine treatment, simultaneously what is to be emphasized is that the treatment must also be according to Chinese medicine syndrome type plus Chinese herb. The three elements efficacy, cost-effectiveness and security analysis are used to evaluate the differences between the two groups. [Results]The experimental group of relin type and qilin type has no statistical y significant difference in the efficacy of the control group.The efficacy of experimental group of xuelin type, gaolin type and laolin type is better than the control group,and cost-effectiveness ratio has no significant difference.There is no serious adverse reaction. [Conclusion] Screening of lower urinary tract infection patients with blood type, cream drench type, combination of traditional Chinese and western medicine treatment, can improve the curative effect.

Forty three medical graduates from Hainan Medical University participating in the standardized general practice residency training in 2015 and 2016 were randomly divided into study group (n=22) and control group (n=21). The study group received a mid-term assessment and formative assessment, and the control group received the final assessment only. At the end of the six months of training, the scores of the mid-term assessment in study group were significantly higher than those in the control group [(82.9±8.4) vs. (75.5±10.2), t=12.706, P<0.01]. A questionnaire survey was conducted among the participants in study group, 86.4% of them recognized and supported the formative assessments. Formative assessment can improve the teaching quality of general practice residency training. The trainees have a positive attitude towards this assessment mode.

OBJECTIVE: To investigate the histopathologic changes of ethmoid bone and its correlation with clinical types of chronic rhinosinusitis (CRS). METHOD: All ethmoid bones and mucosa from 180 patients with CRS after endoscopic sinus surgery were collected for histopathologic detection with HE staining. The number and the rate of cases were counted according to different histopathologic types. To analyze the correlation between ethmoid bones and clinical types of CRS, mucosal pathologic change, the CT-scanning types of sinusitis, the course of disease as well as operational history. RESULT: The ethmoid bone of all patients had varying degrees of histopathologic changes. There were 5 cases (2.78%) in stage I, 38 cases (21.11%) in stage II, 71 cases (39.44%) in stage III, and 66 cases (36.67%) in stage NIV. The histopathologic changes of ethmoid bone varied in different clinical types. In type I, there were 5 cases (8.33%) in stage I, 33 cases (55.00%) in stage II, 15 cases (25.00%) in stage III, and 7 cases (11.67%) in stage NV. In type I, there were 5 cases (8.33%) in stage II, 37 cases (61.67%) in stage mI, and 18 cases (30.00%) in stage NV. In type III, there were 19 cases (31.67%) in stage III, and 41 cases (68.33%) in stage NV. All histopathologic changes of ethmoid bone were statistically correlated (P < 0.01) with clinical types of CRS, pathologic mucosal change, the CT-scanning types of sinusitis, the course of disease as well as operational history. CONCLUSION Almost all patients with CRS manifest different-degrees of histopathologic changes, which are correlated with the clinical types of CRS, pathologic mucosal change, the CT-scanning types, the course of disease as well as operational history.
Adolescent ; Adult ; Chronic Disease ; Ethmoid Bone ; pathology ; Female ; Humans ; Male ; Middle Aged ; Nasal Mucosa ; diagnostic imaging ; pathology ; Radiography ; Sinusitis ; diagnostic imaging ; pathology ; Young Adult

OBJECTIVETo explore the risk factors and prognosis of No.8p lymph node metastasis in cases with advanced gastric cancer.

METHODSClinicopathological and follow-up data of 790 cases with advanced gastric cancer undergoing gastrectomy (including No.8p lymphadenectomy) from October 2003 to October 2013 in Fujian Provincial Tumor Hospital were analyzed retrospectively. Patients receiving neoadjuvant chemotherapy were excluded. Associations of No.8p lymph node metastasis with clinicopathological characteristics and metastasis in other regional lymph node were analyzed. Prognostic difference between positive No.8p group and negative No.8p group was examined.

RESULTSPositive No.8p lymph node was found in 93 cases (11.8%) among 790 cases with advanced gastric cancer. Univariate analysis showed that gender [male 9.8%(56/572) vs. female 17.0%(37/218), P=0.005], preoperative CEA level [<5 μg/L 28.0%(61/218) vs. ≥5 μg/L 5.6%(32/572), P=0.005], tumor size[diameter <5 cm 3.8%(13/346) vs. ≥5 cm 18.0%(80/445), P=0.000], tumor location [gastric fundus and cardiac 10.7% (26/244) vs. gastric body 13.5% (30/222) vs. gastric antrum 10.1% (31/308) vs. total gastric 37.5%(6/16), P=0.007], Borrmann staging [type II( 1.9%(4/211) vs. type III( 11.6% (54/464) vs. type IIII( 30.4%(35/115), P=0.000], tumor differentiation [high 0/8 vs. moderate 6.7%(25/372) vs. low 16.6%(68/410), P=0.000], T staging [T2 2.4%(4/170) vs. T3 13.1%(35/267) vs. T4 15.3%(54/353), P=0.000], N staging [N0 0 (0/227) vs. N1 2.2%(5/223) vs. N2 15.2%(26/171) vs. N3 36.7%(62/169), P=0.000] were closely associated with the No.8p lymph node metastasis. Multivariate analysis that revealed gender (OR=1.762, 95%CI: 1.020-3.043), tumor size (OR=1.107, 95%CI: 1.020-1.203), N staging (OR=4.093, 95%CI: 2.929-5.718), tumor differentiation (OR=1.782, 95%CI:1.042-3.049), and metastasis in No.8a(OR=5.370, 95%CI: 3.425-8.419), No.3(OR=1.127, 95%CI:1.053-1.206), No.6(OR=1.221,95%CI: 1.028-1.450), No.7(OR=2.149, 95%CI: 1.711-2.699), No,11p(OR=2.085, 95%CI: 1.453-2.994), No.14v(OR=2.604, 95%CI: 1.038-6.532) group lymph nodes were the independent risk factors of No.8p lymph node metastasis. One-year, 3-year and 5-year survival rates in positive No.8p group were 85.7%, 47.5% and 22.6%, and those in negative No.8p group were 96.2%, 82.5% and 70.3% respectively, whose differences were significant (χ=109.767, P<0.05).

CONCLUSIONSMetastasis in Np.8p lymph nodes is an important factor affecting the prognosis of patients with advanced gastric cancer. In patients with female gender, tumor diameter ≥5 cm, preoperative late N staging, low tumor differentiation or metastasis in No.8a, No.3, No.6, No.7, No.11p, No.14v group lymph nodes, thorough clean rance of No.8p group lymph node should be considered.

Carcinoembryonic Antigen ; blood ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; physiopathology ; surgery ; Lymphatic Metastasis ; diagnosis ; pathology ; physiopathology ; Male ; Multivariate Analysis ; Neoplasm Grading ; statistics & numerical data ; Neoplasm Staging ; statistics & numerical data ; Prognosis ; Retrospective Studies ; Risk Factors ; Sex Factors ; Stomach Neoplasms ; diagnosis ; mortality ; surgery ; Survival Rate

Objective:To investigate the associations of brain white matter integrity deficits, and to explore the association of fractional anisotropy (FA) abnormality with clinical symptoms and cognitive impairments, as well as the prediction effect of the FA alterations on symptoms and cognitive function outcomes in the acute stage of schizophrenia from the whole brain level based on magnetic resonance diffusion tensor imaging (DTI).Methods:From November 2019 to December 2020, thirty-eight patients with first-episode schizophrenia and 38 healthy controls were recruited in this study. Wisconsin card classification test (WCST), digit span test (DST forward/backward), verbal fluency test, Stroop (A/B/C), trail making test (TMT-A/B), as well as positive and negative syndrome scale (PANSS) were utilized to evaluate patients' cognitive function and clinical symptoms both before and after 8 weeks of risperidone monotherapy. T1-weighted images and DTI data of all the subjects were collected . FSL and SPM8 were used to preprocess MRI data and compare the between-group differences of FA. Support vector machine (SVM) analysis was used to evaluate the accuracy of abnormal FA values in differentiating schizophrenic patients from healthy controls. Finally, stepwise multiple regression analysis or generalized linear models were used to explore the associations between white matter integrity and symptoms or cognition.Results:Before treatment, patients' FA values of right medial temporal lobe (mTL), cuneus, anterior cingulate gyrus (ACG) and inferior parietal lobe (IPL) were significantly lower than those in healthy controls ( P<0.01, GRF corrected), and patients' FA values of bilateral middle cingulate gyrus (mCG) were significantly higher than those in the control group ( P<0.01, GRF corrected). SVM analysis showed that four combinations could distinguish the patients from the control with the most accurate rate of 89.47%. Patients' baseline decreased FA values in the right IPL were positively associated with their increased total response time in WCST ( β=0.489, P=0.003, FDR corrected), correct response time in WCST ( β=0.450, P=0.008, FDR corrected), error response time in WCST ( β=0.435, P=0.008, FDR corrected), TMT-B ( β=0.296, P=0.042, FDR corrected), Stroop-C ( β=0.345, P=0.035, FDR corrected), and PANSS-P ( β=0.321, P=0.042, FDR corrected). Reduced FA values in the right mTL in patient group were significantly negatively related to the total time spent on the TMT-A ( β=-0.425, P=0.009, FDR corrected) and TMT-B ( β=-0.325, P=0.026 with FDR correction). Increased FA values in right mCG in patient group demonstrated positive associations with total response time in the WCST ( β=0.585, P=0.002, FDR corrected), correct response time in WCST ( β=0.524, P=0.003, FDR corrected), error response time in WCST ( β=0.536, P=0.003, FDR corrected) and total time consuming in TMT-B ( β=0.484, P=0.004, FDR corrected), as well as negative associations with DST-forward ( β=-0.319, P=0.042, FDR corrected). After treatment, patients' percentage changes in total response time of WCST ( β=0.715, P<0.001, FDR corrected), correct response time of WCST ( β=0.752, P<0.001, FDR corrected), as well as total time-consuming of TMT-A ( β=1.333, P=0.001, FDR corrected) showed positive correlations with baseline increased FA values in the left mCG. Percentage alteration of Stroop-B was negatively correlated with baseline FA values in the right cuneus ( β=-0.745, P=0.015, FDR corrected). Conclusions:The combination of abnormal FA values in multiple brain regions may be potential biomarkers to distinguish schizophrenic patients from healthy volunteers. There was regional dependence in the associations of the impairment of white matter integrity with the cognitive impairment, the severity of psychopathological symptoms as well as the prognosis of patients in the acute stage.

ObjectiveTo observe the effect of bilateral sequential repetitive transcranial magnetic stimulation on the motor function of upper limbs in stroke patients. MethodsFrom December, 2020 to December, 2022, 62 stroke inpatients in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were included. They were randomly divided into control group (n = 31) and observation group (n = 31). Both groups accepted conventional medicine and rehabilitation, as well as electroacupuncture antagonistic muscle therapy. Before electroacupuncture, the observation group acceped low-frequency repetitive transcranial magnetic stimulation at primary motor cortex (M1) on the healthy side, followed by intermittent theta burst stimulation at M1 on the affected side, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Barthel Index (MBI) and modified Ashworth Scale (MAS), and motor evoked potential (MEP) latency was compared before and after treatment. ResultsOne patient dropped down in the observation group, and no adverse event happened. After treatment, the scores of FMA-UE and MBI significantly increased (|t| > 9.953, P < 0.001), and the score of MAS and the latency of MEP significantly decreased (|t| > 5.043, P < 0.001) in both groups; while all of them were better in the observation group than in the control group (|t| > 2.237, P < 0.05). ConclusionBilateral sequential repetitive transcranial magnetic stimulation can effectively promote the recovery of upper limb motor function in stroke patients.