Objective To evaluate the curative methods of periampullary diverticula(PAD) complicated with biliopancreatic disease.Methods The clinical data of 32 cases of PAD complicated with biliopancreatic disease treated by surgical or endoscopic measures were retrospectively analyzed.Results Of the 32 cases,16 cases were treated with gastroectomy and Roux-en-Y gastrojejunostomy,and 8 with gastroectomy and Billroth Ⅱ gastrojejunostomy,8 with endoscopic sphincterotomy (EST).Postoperative complication occured in 4 cases,but no operative death.Twenty-seven cases were followed up for 5 months-8 years, and the results were excellent in 20 cases, good in 7 cases.Conclusions Gastroectomy and Roux-en-Y gastrojejunostomy is a better surgical method for PAD complicated with biliopancreatic disease.EST has become a new effective measure to deal with the diseases;It will be safe to use the first method for patients with intradiverticular papilla if it treated by EST.

Objective To investigate the effects of functional electrical stimulation (FES) on motor function and the expression of bromodeoxyuridine (Brdu) + and glial fibrillary acid protein (GFAP) + in the subventricular zone (SVZ) of rats with acute cerebral infarction,and to explore it's mechanism. Methods A rat model of cerebral infarction was established using Longa's technique for middle cerebral artery occlusion (MCAO) with an intraluminal filament.The rats were randomly divided into a FES group,a placebo stimulation group and a control group.In each group,rats were randomly allocated into 1 d,3 d,7 d and 14 d subgroups (6 rats/subgroup).Superficial electrodes were pasted on the paralyzed forelimbs of rats in the FES group for connecting with the FES instrument,and FES treatment was carried out with a current of 4-5 mA for 15 min on the third day after the MCAO operation to produce extension of the wrist and the digits of the paralyzed forelimb.The rats in the placebo stimulation group were pasted with electrodes,but no FES was administered and they received no other treatment.Neurological deficits were evaluated using the modified neurological severity score (mNSS) before treatment and on the 1 st,3rd,7th,and 14th day after treatment. BrdU and GFAP positive cells in the SVZ were detected by immunofluorescence techniques.Results After 7 or 14 days the motor function of rats in the FES group had improved significantly compared with the placebo stimulation and control groups.Compared with the other two groups,the expression levels of BrdU+ and GFAP+ cells in the ischemic SVZ in the FES group were significantly higher at the 3rd,7th and 14th day.Conclusion FES can improve motor function after acute cerebral infarction and also promote the proliferation and differentiation of neural stem cells in the SVZ.

Objective To study changes in synaptic plasticity in the contralesional mirror area of the cortexes of rats with cerebral infarction treated by low-frequency electrical stimulation(LFES)and to explore the therapeutic mechanism of LFES on the molecular level.Methods Forty-eight Sprague-Dawley rats were randomly allocated into a LFES group,a placebo group and a sham-operation group.Following middle cerebral artery occlusion(MCAO),rats in the LFES group were treated with LFES for 7 d(20 min/d),while the ones in placebo group were connected with the same LFES device but without electricity.Rats in the sham-operation group were subjected to a MCAO operation without occlusion and then received no special treatment.Synaptic ultra-structures and the expression levels of glia fibrillary acidic protein(CFAP)and synaptophysin in the contralesional mirror area of the cortexes of the rats in each group were measured with electron-microscopy and Western blotting.Results Compared with the placebo group or the rats before treatment,rats treated with LFES exhibited ultra-structural changes in the form of larger curvature of synaptic interfaces and narrower synaptic clefts.GFAP expression levels did not fluctuate significantly,but the expression of synaptophysin was significantly up-regulated.Conclusion LFES treatment can induce active changes in synaptic plasticity in the contralesional mirror area of the cortex of rats after cerebral infarction.

Objective To study the effects of low-frequency electrical stimulation(LFES)on motor function and the expression of glia fibrillary acidic protein(GFAP)around cerebral infarction sites in rats.Methods Fifty-four male adult Sprague-Dawley rats were randomly divided into a LFES group,a placebo group and a sham operation group(18/group).All groups were randomly divided into 3 treatment groups.A rat model of middle cerebral artery occlusion(MCAO)was established using intraluminal filament occlusion.Treatment was carried out 3 d after the operation.Rats in the LFES treatment groups were stimulated with LFES for 3,7 or 14 days (10 min/d);the placebo groups were treated in the same way without electric stimulation;the sham operation subgroups didn't receive any therapy.Scores on a beam-walking test,a rotating pole test and a screen test were assessed at each time point mentioned above.Expression of GFAP was also assessed using immunohistochemcal techniques.Results The paralysed limbs recovered motor function better in the LFES groups than in the control groups.GFAP-positive cells were more numerous at the margins of the infarction area in the treated groups than in the control groups.Conclusions LFES might increase the expression of GFAP,which might be an important mechanism in improving brain plasticity after cerebral ischemia,aiding the recovery of the central nervous system and rebuilding its functioning.

Objective To explore the relationship between cardiac involvement and laboratory indicators in patients with rheumatoid arthritis(RA). Methods Cardiac echocardiography and ECG performance of 184 patients with RA were analyzed retrospectively. Results Among the 184 patients with RA, the pulmonary hypertension detection rate was 8. 3%, valvular disease 38. 9%, arteriosclerosis 27. 8%, wall to reduce the exercise 13.9%, myocarditis 5.6% and pericardial effusion 5.6%, according to the echocardiography examinations;Sinus tachycardia was evidenced in 15. 22% patients, ST-T changes in 39. 13%, electric axis left side in 8. 70%, branch block in 13.04%, left ventricular hypertrophy in 4. 35%, atrial fibrillation in 4. 35%, premature in 8.70%, early repolarization syndrome in 2. 17% and electric-axis right side in 4. 35% patients by ECG examinations. The serum level of CRP (46. 77 ±5. 87) mg/L was significantly higher in RA patients with cardiac involvement than that in the non-cardiac involvement patientsm (28. 45 ±3. 21) mg/L (P ＜0.05) ;While the serum level of ESR,RF,IgG,IgA,IgM, PLT showed no statistically significant differences between the two groups (P ＞ 0.05); Within RA patients withcardiac involvement, the serum level of CRP showed no significant difference among different sub-groups , which were classified according to the echocardiography performance (P ＞ 0.05). Conclusions Cardiac involvement occurred frequently in patients with rheumatoid arthritis. The valvular disease, arteriosclerosis, reducing of the wall motion and pericardial effusion are the main manifestations by echocardiography examination; Sinus tachycardia, ST-T changes,branch block and premature beats are the main ECG abnormalities. The serum level of CRP is significantly higher in RA patients with cardiac involvement than that with non-cardiac involvement patients. The higher level of CRP in patients with RA may indicate the cardiac involvement presence.

Objective To study the effects of different types of exercise training on learning and memory, as well as on the expression of synaptophysin (SYP) and on postsynaptic density protein 95 (PSD-95) in rats in which a model of vascular dementia had been created.Methods Forty male Wistar rats were divided randomly into a voluntary exercise group (V-EX) , a forced exercise group (F-EX) , an involuntary exercise group (I-EX) , a vascular dementia group (VD) and a sham-operation group (Sham) , with 8 rats in each group.Two-vessel occlusion (2-VO) of the arteria carotis communis was used to create a model of vascular dementia in all of the rats except those in the sham-operation group.Beginning one week after the surgery, the V-Ex rats were free to run in a running wheel.The F-EX rats were forced to run 270 m a day in an electric wheel.The I-EX rats were stimulated to imitate the gait pattern of their forelimbs running at 9 m/min three times a day for l0 minutes each time.No special training was given to the rats in the other 2 groups.Three weeks after the surgery, their learning and memory were tested using a novel object recognition test.Immediately after the test, their prefrontal cortex was sampled and the expression of SYP and PSD-95 was detected using western blotting.Results The average novel object recognition indices of the rats in the V-EX, F-EX and I-EX groups were all significantly higher than that of the VD group.Average PSD-95 expression was also significandy higher than in the VD group.Conclusion Exercise, whether voluntary, forced or induced by functional electrical stimulation can improve learning and memory in vascular dementia, at least in rats.The mechanism is possibly that the training can increase the expression of PSD-95 in the prefrontal cortex, though not SYP.

INTRODUCTIONNon-melanoma skin cancer is one of the commonest cancers in Singapore and worldwide. The aim of our study was to evaluate the demographic and clinicopathological patterns of squamous cell carcinoma (SCC) and Bowen's disease (BD) of the skin, in order to better understand the characteristics of these tumours in our population.

MATERIALS AND METHODSHistologically proven cases of SCC and BD seen at our centre between 2002 and 2003 were retrospectively analysed according to age, sex, race, predisposing factors such as immunosuppression and ultraviolet therapy, site and size of tumour, histological differentiation and subtype, and treatment method.

RESULTSA total of 161 patients were studied--81 with SCC, 68 with BD, and 12 with both tumours. There were 199 tumours in total--105 SCC and 94 BD. For both SCC and BD, males outnumbered females (ratio of 2.4:1 and 1.5:1 respectively); patient age averaged 72.9 years and 66.8 years respectively; and Chinese were the majority race. The mean duration to presentation was 21.2 months for SCC compared with 39.9 months for BD, and common symptoms were itch, pain and bleeding for both. The mean tumour size was 19.0 mm and 18.5 mm, and the commonest site was the head and neck for both.

CONCLUSIONSSCC and BD show rather similar patient characteristics, with a predominance among males, having a predilection for the head and neck region, and with a tendency towards slow growth. As incidences increase worldwide, it is important for healthcare providers to be adept at recognising and managing nonmelanoma skin cancers.

Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Bowen's Disease ; epidemiology ; Carcinoma, Squamous Cell ; epidemiology ; Extremities ; Female ; Head and Neck Neoplasms ; epidemiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; epidemiology ; Skin Neoplasms ; epidemiology