Objective To study the correlation between clinical rating scale and the duration of multiple system atrophy.Methods One hundred and twenty-two MSA cases fulfilling Gilman diagnostic criteria were recruited.Unified Multiple System Atrophy Rating Scale(UMSARS)was applied to assess the degree of the patients' disability.For analyzing the correlation between the UMSARS scores and the duration of the disease,the Spearman's rank correlation coefficients were calculated.Results Among 122 MSA cases,male:female ratio was 1.7:1;disease duration lasted(2.8±1.6)years:possible MSA accounted for 50 cases(41%),probable MSA 72 cases(59%);MSA-P 35 cases(29%);MSA-C 73 cases(60%).MSA-P+C 5 cases(4%),MSA-A 9 cases(7%).The scores of UMSARS,UMSARS-Ⅰ and UMSARS-Ⅱ were found positively correlating with the disease duration.The Spearman's rank correlation coefficients were 0.368,0.266 and 0.392 respectively,all P<0.01;the adjusted Spearman's rank correlation coefficients were 0.360,0.257 and 0.385 respectively.all P<0.01.Conclusions MSA has complex clinical manifestations.which should include MSA-P+C subtype.UMSARS is a reliable scale to mirror the progression of MSA.which is useful to study the clinical features and disease duration of MSA.

Objective To study the clinical and neuroimaging features of subtypes of multiple system atrophy (MSA) and their correlations. Methods One hundred and forty-three MSA cases fulfilled Gilman diagnostic criteria (1999) were recruited and their clinical subtypes and stages were classified. Using the staging methods of the pontine cross sign and putaminal slit proposed by Horimoto, 108 patients showed abnormalities in MRI and were further evaluated. The relationship between the subtypes of MSA, disease duration, and MRI abnormalities has been analyzed. Results Of 143 MSA patients, the male-to-female ratio is 1.3:1 ; 93 cases are diagnosed with MSA-C, 39 with MSA-P, and 11 with MSA-P + C; 90 cases with probable diagnosis, and 53 with possible diagnosis. Of the 76 MSA-C cases with MRI abnormalities, 36 (47%) show the pontine cross sign and 10 (13%) show the putaminal slit; of the 24 MSA-P cases with MRI abnormalities, 6 (25%) show the pontine cross sign and 6 (25%) show theputaminal slit. In addition, MSA-C cases with shorter disease duration demonstrate earlier stages of the pontine cross sign. Conclusions In this study, the number of MSA-C cases is more than MSA-P, which might be related to the ethnic background. In neuroimaging, both the pontine cross sign and the putaminal slit are the marked features of MSA. To some degree, the subtypes of MSA are related with the features of imaging, that is, MSA-C patients present the pontine cross sign more often than MSA-P, and the putaminal slit is a comparatively common feature among MSA-P cases.

The clinical practice is a very important link for medical students to relate theory with practice and to be trained comprehensively.Stomatology is an applied science,so clinical practice is more outstanding and important during the stomatological education.This thesis discusses how to improve stomatological students' comprehensive skill in the clinical practice.

Objective:To observe the clinical therapeutic effect of needling the acupoints of Governor Vessel and Bladder Meridian plus cupping on chronic fatigue syndrome. Methods: Fifty cases of chronic fatigue syndrome were divided into the treatment group(n= 25) and the control group(n=25). The patients in the treatment group were treated by needling Dazhui (GV 14), Zhiyang (GV 9),Xinshu (BL 15), Geshu (BL 17), Mingmen (GV 4), Shenshu (BL 23) and Changqiang (GV 1). Even reinforcing and reducing manipulation was used. Every time after the needles were withdrawn, the glass jar with thick and smooth mouth was selected to go on the back. The patients in the control group were treated by taking Chinese medicinal herbs, Caili composition, orally. Results: After 3durations of treatment, the therapeutic effects of the two groups were 92. 0% and 64. 0%respectively. There was significant difference in the therapeutic effect between the two groups(x2 =7.29,P ＜ 0.05).Conclusion: Acupuncture plus cupping is an effective method in treating chronic fatigue syndrome.

Objective To investigate the clinical features and genetic mutations of spinocerebellar ataxia type 17 (SCA17).Methods The pathological CAG triplet repeat expansions of the SCA3,SCA1,SCA2,SCA6,SCA7,SCA8,SCA12,SCA17 and dentatorubral pallidoluysian atrophy genes were analyzed in 708 probands of autosomal dominant familial SCA and 1 19 sporadic SCA cases.The CAG repeats of TATA-binding protein (TBP) gene were amplified by means of polymerase chain reaction and agarose gel electrophoresis.For the samples with two alleles,fragment analysis based on CEQ8000 sequencer was applied to analyze the CAG repeat numbers.Furthermore,the correlation between clinical features and CAG repeat in the TBP gene was studied carefully.Results The expanded CAG repeats in the TBP gene was detected in 5 cases with 37/50,36/45,38/52,38/53,36/54 separately.And the main clinical manifestations were ataxia and memory impairment.Conclusion These findings indicate that SCA17 might be a rare subtype of SCA in the Chinese population and the clinical features of SCA17 cover a wider spectrum than previously reviewed.

Objective To explore the clinical safety and validity of Da Vinci surgical system in distal pancreatic tumor resection.Methods The clinical data of 14 patients with distal pancreatic tumor underwent robotic surgeries by using Da Vinci surgical system from January 2009 to June 2012 were retrospectively analyzed.Results The average operation time was 343.93 (170-575) min,average blood loss was 192.5 (10-700) ml,without blood trahsfusion.Pathologic examination showed:pancreatic ductal adenocarcinoma in 7 patients,pancreatic cystadenoma in 1 patient,mucous cystadenoma in 1 patient,cystadenocarcinoma in 1 patient,high levels of pancreatic ductal intraepithelial neoplasia in 1 patient,insulinoma in 1 patient,solid pseudo-papillary tumor in 2 patients.Two patients with pancreatic leaks after operation and then relieved after conservative medical therapy.Others were discharged from hospital without complications.The average hospital stay was 10.64 d.Conclusions Da Vinci surgical system is safe and effective in treatment for patients with distal pancreatic rumor with minimally invasive advantage.Because lack of surgical experience and small sample,a large sample with long term follow-up of high-quality clinical research is required and then update the system to evaluate the efficacy and safety.

ObjectiveTo explore the value of expanded radical resection for gallbladder cancer located respectively at body and bottom of the gallbladder and at the neck.MethodsIn this study,91 cases of gallbladder cancer were macropathologically divided into two groups, one with the lesion at the body and bottom of the gallbladder and the other at the neck, survival analysis was made accordingly. Three different kinds of resection were performed: the expanded radical resection, the standard radical resection and palliative operation.ResultsThe overall median survival rate of patients undergoing expanded radical operation was significantly longer than that of the cases doing other two procedures, that was 27. 1 ± 2. 4,10. 7 ±2. 2,4. 7 ±2.2 (months) respectively for body and bottom cancer, and 8.5 ±2. 1,6. 7 ± 1.9,3.1 ± 1.1 (months) respectively for neck cancer. For cancer at the body and bottom RO was achieved by expanded radical resection in 16/18(88％ ) cases and by standard radical resection in 7/12(58％ ) cases, while for cancer at the neck it was in 6/16(38％ ) cases, and in 3/13 (23％)cases only.ConclusionsThe median survival time is longer and RO resection rate is higher in patients with the cancer at the body and bottom than these at the neck of the gallbladder.

Objective To investigate the characteristics of PMP22 duplication mutation and the clinical variability of Charcot-Marie-Tooth disease type 1A (CMT1A) patients. Methods PMP22 duplication mutation analysis were performed in 45 cases diagnosed probably CMT by combination of improved allele-specific PCR-restriction enzyme digestion and short tandem repeat (STR) analysis based on laser-induced fluorescence detection in capillary electrophoresis. The clinical features of the positive cases were precisely analyzed. Results With the combined use of two methods, PMP22 duplication was detected in 21 cases, i.e. 10 CMT1 cases with typical presentations including weakness and atrophy in the distal limbs, and 11 atypical cases with special phenotypes including 1 case with mild dizziness, 1 case with hearing loss, 2 cases with recurrent limbs weakness, 2 cases with postural tremor in the upper limbs, 4 cases with cerebellar ataxia and 1 case with epilepsy. Conclusions The improved allele-specific PCR-restriction enzyme digestion provides the accurate, reliable and feasible method to detect PMP22 duplication, which is the most common cause of CMT. Comprehensive analysis of clinical, electrophysiological and pathological features of the CMT1A patients with positive PMP22 duplication indicate the high clinical variability of this disease.

Objective To investigate the effects of comprehensive psychological intervention on psychological and biochemical indexes of servicemen in three degree combat readiness. Methods 189 servicemen in three degree combat readiness were randomly divided into the study group and the control group by squad. Beyond the same exercise and education as the control group, the study group received the comprehensive psychological intervention in the course. They were all assessed with Self-rating Depression Scale (SDS) ,self-rating anxiety scale (SAS) ,and simplified coping style questionnaire (SCSQ) at the day entering three degree combat readiness (prereadiness) and the next day after the mission (post-readiness). The serum concentrations of superoxide dismutase ( SOD), malondialdehyde ( MDA), cortisol ( COR), and aldosterone (ALD) were determined to evaluate biochemical indexes at the same time. Results Compared with the control group after the combat readiness, the total scores of SDS( (42.1 ± 9.3 ) vs (49.2 ± 10.3 ) ) and SAS( (43.8 ± 7.2) vs (50.6 ± 10.2), P＜ 0. 01 ) were lower, the score of the positive coping style ( ( 21.2 ± 6.4) vs ( 18.2 ± 5.4), P ＜ 0. 05 ) was higher in the study group.Meanwhile,the levels of MDA( (2.6 ±0.51 ) μmol/L) ,COR( (252.5 ±52.4) ng/ml) ,and ALD ( (97.5 ±24.4) pg/ml) were lower ( P ＜ 0. 01 ), the activity of SOD ( ( 1551 ± 354 ) U/gHb) was higher ( P ＜ 0. 01 ) after the combat readiness. In the control group post-readiness, the total scores of SDS (49.2 ± 10.3) and SAS (50.6± 10.2) ,the levels of MDA ( (2.9 ±0.35 ) μmol/L) ,COR( (333.8 ±62.6) ng/ml) ,and ALD( ( 123.8 ±29.6)pg/ml ) increased significantly (P＜0.01), the score of the positive coping style ( 18.2 ± 5.4) and the activity of SOD ( 1302 ± 352 ) U/gHb decreased significantly ( P ＜ 0. 01 ). The total scores of SDS, SAS were negatively related to the level of SOD ( r= -0. 142, -0. 119, P＜0. 0lor 0.05) ,and positively related to COR ( r=0. 156,0. 159, P＜0. 01 ) and ALD ( r=0.151,0.156, P＜0. 01 ). The score of positive coping style was positively related to the level of SOD ( r=0. 141, P＜0. 01 ) ,and negatively related to COR and ALD ( r= -0. 152, -0. 155, P＜ 0. 01 ). Conclusion Comprehensive psychological intervention could effectively improve the psychological and biochemical indexes,reduce the stress level of servicemen in three degree combat readiness.

Objective To explore the cultivated methods of dendritic cells (DC) and the killing effect of DC stimulated by CpG ODN1826 on gastritic cancer cells MKN45 in vitro. Methods DC was induced from peripheral blood monocytes stimulated by A group ( GM- CSF + IL-4 ), B group ( GM- CSF + IL-4 + TNF- α), C group(nonCpG ODN) and D group( CpG ODN 1826). The surface markers of DC was analyzed via flow cytometry, and the abilities to stimulate proliferation of allogenic lymphocyte by DC and antitumor experiment were detected by MTT assay. Results On day 10, a majority of cells showed typical morphology of DC in D group and B group with visible branching-like and pseudopod-like structures under microscope. The results of flow cytometry showed that there are significantly high expressed co-stimulated molecules such as CD40, CD1a,CD80, CD86 and MHC- Ⅱ in D group compared to other experimental groups ( P ＜ 0.05 ), which dramatically stimulate the proliferation of allogenic lymphocytes and enhance the killing activity of DC on gastric cancer cells. Conclusion This method can acquire relatively high purified DC, and CpG ODN can significantly induce the differentiation and maturation of DC isolated from peripheral blood and enhance the killing activity of DC on MKN45 by stimulating PBMC in vitro.