The silent cerebral infarct is an clinic symptom that is so slight or transitory as to be easily neglected. There are only neural symptoms and signs,but irresponsible infarct focus can be seen on image. The risk factors of silent cerebral infarct may be the same as those of symptomatic cerebral infarct. Such infarct is likely to influence the course, clinic symptom and prognosis of acute cerebral infarct and may foretell symptomatic cerebral infarct and deteriorate into pseudo-global paralysis or multi-infarcted dementia. Therefore elder who suffer from hypertension or diabetes and experience vertigo, headache, language barrier but without apparent signs and symptoms should receive cerebral CT or MRI. Minor or third-degree precautionary measures can be taken as a chief therapy for cerebral infarct. Alternatively vitamines B_6,B_(12) and folic acid can be supplied to reduce the chance of hyperhomocysteinemia. Headache is the initial symptom in silent brain infarct. Magnesium is effective when dehydration does not work.

OBJECTIVESTo evaluate the efficacy and toxicity of the B-NHL-BFM-90 protocol in the treatment of Chinese childhood and adolescent B-cell non-Hodgkin's lymphomas (B-NHL).

METHODSForty-two untreated childhood and adolescent B-NHL were enrolled in the present study. Of them 18 cases were Burkitt's lymphoma, 16 diffuse large B cell lymphoma and 8 anaplastic lymphoma. There were 10 cases in stage II and 32 in stage III/IV. The patients were grouped by risk factors into low, medium and high risk groups. All patients were treated with the B-NHL-BFM 90 (Berlin-Frankfurt- Münster) protocol. The low risk group received A, B courses for 4 cycles, the medium risk group AA, BB courses for 6 cycles, and the high risk group AA, BB, CC courses for 6 cycles.

RESULTSComplete remission (CR) was obtained in 37 patients (88%), and partial remission (PR) in 5 (12%). Of the 5 PR patients, I received autologous hematopoietic stem cell transplantation, 3 received radiotherapy for residual disease and 1 just under watching. Major toxicity was myelosuppression and mucositis, especially in AA, BB and CC cycles, but was tolerant and manageable. Median follow-up was 20 (4 - 89) months. Kaplan-Meier method was used to analyse survival data. Two year event free survival (EFS) for all patients was 86. 24%, being 100% for stage II and 80.95% for stage III/IV.

CONCLUSIONShort term and intensive chemotherapy can improves the efficacy and survival rate of childhood and adolescent B-NHL, especially for advanced stage patients.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; adverse effects ; Child ; Child, Preschool ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Infant ; Lymphoma, B-Cell ; drug therapy ; Male ; Retrospective Studies ; Treatment Outcome

BACKGROUNDOcclusal splints have been the preferred modalities in the management of myofascial temporomandibular disorders (TMDs), but now controversy exists in reporting whether they are successful for TMDs treatments. The aim of this study was to give objective evidence to the assessment of treatment effect of occlusal splints for myofascial TMDs patients by clinical assessments and surface electromyography (sEMG) measurements of masseter muscles (MM).

METHODSThirty-six patients (12 males and 24 females) aged 16 - 57 (38 ± 11) years participated in the study. All participants diagnosed with myofascial TMD were randomized into two groups (18 of each). Patients in the first group (A) were treated with occlusal splints for 1 month, while patients in the second group (B) were treated with placebo (non-occluding palatal) splints. Clinical assessments were performed at the beginning of the study and 1 month after treatment. sEMG measurements for MM were performed at mandibular postural position (MPP) and maximum intercuspal contacted position (ICP) 1 month after the treatment. The root mean square (RMS) and the median frequency (MF) as linear indices of sEMG data were used to demonstrate muscle activity and muscle fatigue. Data were analyzed by ANOVA and post hoc SNK test. The differences were considered significant at P < 0.05.

RESULTSIt was found that 89% of group A either completely recovered (39%) or clinically improved (50%), while only 22% of group B had a spontaneous improvement. sEMG analysis showed that at MPP, the mean of RMS value of MM in group A was lower than that of group B, which shows statistical differences (P < 0.01). At ICP, the RMS value of MM in group A was higher than that of group B, which shows statistical differences (P < 0.01). At MPP, MF value of MM in group A was higher than that of group B (P < 0.05). At ICP, MF value of MM was lower than that of group B (P < 0.01).

CONCLUSIONSOcclusal splint could eliminate or improve the signs and symptoms of TMD patients with myofascial pain. sEMG analysis indicates that the wearing of occlusal splints may reduce the degree of fatigue of the masticatory muscles. The splint therapy outcome has a correlation with the electromyographic changes in the masticatory muscles.

Adolescent ; Adult ; Double-Blind Method ; Electromyography ; Female ; Humans ; Male ; Middle Aged ; Myofascial Pain Syndromes ; physiopathology ; therapy ; Splints

OBJECTIVETo look for the active fraction of ethanol extract of Genkwa Flos (EGF) induced hepatotoxicity and develop an UPLC fingerprint of the active fraction.

METHODTarget fraction of EGF induced hepatotoxicity was guided by the serum biochemical and histopathology methods. The UPLC method was applied to establish the chromatographic fingerprint. The separation was achieved on a BEH C18 column (2.1 mm x 50 mm, 1.7 microm) with a mobile phase consisting of acetonitrile and water containing 0.05% phosphate acid running gradient elution. The detection was carried out at 210 nm and the analysis was finished within 10 min.

RESULTThe chloroform phase of EGF could be responsible for the hepatotoxicity of this herb. The common mode of the UPLC fingerprint was set up under the established condition. There were 17 common peaks in fourteen batches of herbs, eight of which were identified, and the similar degrees of the fourteen batches to the common mode were between 0.890-0.999.

CONCLUSIONIt is easy to locate the chloroform extraction of EGF with hepatotoxicity. And the UPLC fingerprint was developed for the above fraction, which could provide valuable references for safe and effective clinical use of EGF.

Animals ; Asteraceae ; chemistry ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; analysis ; toxicity ; Flowers ; chemistry ; Humans ; Liver ; drug effects ; Male ; Rats ; Rats, Wistar

Objective To discuss the treatment of ureteropelvic junction obstruction by laparoscopic pyeloplasty. Methods A retrospective review of consecutive laparoscopic pyeloplasty in 102 patients between September 2001 and December 2007 was performed. The ureterpelvic junction was dissected and the obstruction portion was excised. Anastomosis was then performed through the ureter and the renal pelvis walls with a stent. Results The mean operating time was 120 min and the average blood loss was 80ml. No major complication occurred intraoperative. The drainage was removed in 3-10 days. The average hospital stay was 8.5 days. The stent was kept for 30-60 days. IVU and B ultrasound examination revealed that the hydronephrosis alleviated during the follow-up and no anastomosis stricture occurred. Conclusions Laparoscopic dismembered pyeloplasty could provide lower morbidity, shorter hospital stay, and faster convalescence. It could be an effective treatment for ureteropelvic junction obstruction.

Objective To study the anatomical classification and surgical management of communicating tumors invading the anterior or middle skull base. Methods According to the location and growth direction of the tumors, the communicating tumors invading the anterior or middle skull base in 29 patients were classified into 4 types, namely fronto-naso-orbital tumors in 16 cases, middle-lateral cranial base tumors in 8 cases, central-medial skull base tumors in 4 cases and petrous bone-jugular foramen tumor in 1 case. Based on this classification, extended transbasal approach (13 cases), supraorbital-pterional approach (9 cases), fronto-temporal approach (3 cases), ffontotemporal-orbitozygomatic approach (3 cases) and transpetrol approach (1 case) were adopted for tumor resection and skull base defect reconstruction. In the transbasal approach group, the surgery was performed also through transnasal endoscopic approaches. Results Twenty-four patients underwent total tumor resection and 5 had subtotal tumor resection. No operative death or serious complications (e.g. intracranial infection, cerebrospinal fluid leakage or meningoencephalocele) occurred after the operations. Conclusion Classification of the communicating tumors invading the anterior or middle skull base according to their location and growth direction facilitates planning of the surgical approaches for tumor resection and skull base defect reconstruction.

OBJECTIVETo investigate the clinical characteristics and managements of pyothorax due to postoperative cervical anastomotic leakage after esophageal cancer surgery.

METHODSFrom January 2006 to January 2013, 3342 patients with esophageal carcinoma underwent esophagectomy and cervical esophagogastric anastomosis. Of them, 19 patients developed pyothorax following cervical anastomotic leakage and their clinicopathological data were analyzed retrospectively.

RESULTSAll the patients underwent a cervical anastomosis via a three-incisional approach (right cervicothoracic mid-abdominal incision, RT group, n=1094) or a two-incisional approach (left cervicothoracic incision, LT group, n=2248). The total number of cervical anastomotic leakage cases was 237, of which 152 cases were in LT group (6.8%), and 85 cases in RT group (7.8%), respectively (P=0.287). The incidence of pyothorax was 2.0% (n=3) in LT group, and 18.8% (n=16) in RT group, respectively (P<0.01). Fourteen cases develop pyothorax within 3 days after operation. The main symptoms were high fever, dyspnea and chest pain. All the pyothorax patients received conservative treatments, including thoracic closed drainage, nasogastric tube placement, jejunal stoma, nutritional support, antibiotics and symptomatic treatment. Sixteen cases were cured, while 3 cases were dead.

CONCLUSIONSThe right thoracotomy approach predisposes the cervical anastomotic leakage-associated pyothorax. Sufficient drainage and sufficient nutritional support are critical to the treatment.

Aged ; Anastomotic Leak ; Drainage ; methods ; Empyema, Pleural ; etiology ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Retrospective Studies

OBJECTIVETo study the etiopathogenesis, clinical manifestations, diagnosis and management of persistent Müllerian duct syndrome (PMDS).

METHODSTwo cases of PMDS were reported, one accompanied by transverse testicular ectopia and the other associated with cryptorchidism. Corporeal hysterectomy and orchidopexy were given to both the patients and cryptorchidectory the latter.

RESULTSVascular supply and texture of the testis were normal in both the 2 patients after 1.5-2 years' follow-up.

CONCLUSIONPMDS is male pseudohermaphroditism, for which means should be taken to preserve the blood supply and fertility function of the testis in surgical management, and attention should be paid to possible development of testis tumor in follow-up.

Adult ; Disorders of Sex Development ; pathology ; Follow-Up Studies ; Humans ; Male ; Mullerian Ducts ; abnormalities ; Syndrome

OBJECTIVETo investigate the association of the risk of prostate cancer (PCa) with the polymorphism of the CYP2E1 gene, smoking and drinking, and to explore the joint role of genes and living habits in PCa pathogenesis.

METHODSWe conducted a case-control study on 109 PCa patients and 202 age-matched non-PCa male controls, and detected the polymorphisms of CYP2E1 Rsa I and Pst I sites by PCR-RFLP using DNA from peripheral blood lymphocytes.

RESULTSThe history of deep smoking (OR = 2.29, 95% CI: 1.28 - 4.09) or heavy smoking (OR = 1.81, 95% CI: 1.02 - 3.22) was a risk factor. The CYP2E1 C1/C1 genotype significantly increased the risk of PCa (OR = 1.71, 95% CI: 1.04 - 2.82) and apparently interacted with drinking (OR = 2.21, 95% CI: 1.06 - 4.59). Heavy smokers with the C1/C1 genotype showed an increased risk of PCa (OR = 2.80, 95% CI: 1.20 - 6.56), as compared with non-smokers carrying the genotype of C1/C2 or C2/C2.

CONCLUSIONThe risk of PCa obviously increases in individuals with both the CYP2E1 C1/C1 genotype and the habit of smoking or drinking, and it has a significant positive correlation with the dose of tobacco exposure.

Aged ; Alcohol Drinking ; epidemiology ; genetics ; Case-Control Studies ; China ; epidemiology ; Cytochrome P-450 CYP2E1 ; genetics ; Genetic Predisposition to Disease ; Humans ; Male ; Middle Aged ; Polymorphism, Genetic ; Prostatic Neoplasms ; epidemiology ; genetics ; Smoking ; epidemiology ; genetics

Objective:To summarize our experience of retroperitoneal laparoscopic living donor nephrectomy,our continuous technical improvements and refinement of this skill and standardization of each procedure of this operation.Methods:Having approved by hospital ethical committee and local government administration,a total of 193 living donors underwent retroperitoneal laparoscopic living donor nephrectomy from Dec.2003 to Feb.2016 in our department.Under general anaesthesia,the operation was performed through 3 lumbar ports.After the kidney was liberated fully and the ureter was severed 7-8 cm under the lower pole of the kidney,the renal artery and vein were blocked with endo-cut or hem-o-lok separately and then severed.Then the kidney was taken out quickly and flushed with 4 ℃ kidney preserving fluid immediately,the donor kidneys were then preserved in iced saline until kidney transplantation.Clinical data about operation time,volume of blood loss,perioperative complications,renal function of both donors and recipients before and after operation were collected.Results:The 193 retroperitoneal laparoscopic living donor nephrectomy operations were successful with only one operation was converted to open living donor nephrectomy because of hemorrhage and unclear operation field during the operation.The average operation time was 85 min (55-135 min),the average blood loss was 60 mL (20-200 mL),and no donor needed blood transfusion during or after operation.Three donors were found to have hematoma of renal fossa after operation and none of them required further treatment.The average hospital stay after operation was 5.7 days (4-9 days).In the study,162 donors were followed up for an average of 42 months (1-58 months) and they were all healthy.Two kidney recipients had urinary bladder anastomosis leakage after operation and both needed surgical repair,a new anastomosis of ureter and bladder were made.Three kidney recipients had kidney subcapsular hematoma but required no further treatment.One kidney recipient had delayed graft function and recovered finally and the renal function of other recipients were all normal.Renal function of both donors and recipients during the follow up period were normal.Conclusion:Retroperitoneal laparoscopic living donor nephrectomy is a safe and reliable technique,it may become a standardized operation for living kidney transplantation after continuous technical improvement.Precautions must be taken to avoid complications and a skilled hand is necessary for success.