Objective To study the clinical significance of molecular markers and routine coagulation tests in patients with cerebral infarction and to set up a serial programs of laboratory diagnosis,monitoring and treatment of cerebral infarction.Methods Prothrombin fragment 1+2(F1+2),thrombin antithrombin III complex(TAT), D-dimer(D-D),Von willebrand Factor(vWF),antithrombin(AT), protein C(PC),prothrombin time(PT),activated partial thromboplastin time(APTT) and thrombin time (TT) were determined in 90 patients with cerebral infarction and 60 normal control subjects.Results The levels of F1+2,TAT,D-D,vWF were significantly higher in patients with cerebral infarction than that in control subjects. But the levels of PC,AT,PT,APTT,TT in patients with cerebral infarction were no different from that in control subjects.Conclusion There were hypercoagulable states in patients with cerebral infarction.The activity of prothrombin is higher, thrombin is generated more, the activity of fibrinolysis is higher too, but anticoagulation system is not sufficiently activated .Meanwhile, perhaps endothelial lesion would be the main role of coagulation system activating and pathogenesis.Molecular markers such as F1+2,TAT,D-D,VWF can be as diagnositic signs but routine coagulable tests can not display the hypercoagulable states in patients with cerebral infarction.

Objective To study the clinical application of the complete audiologic evaluation battery consisting of ABR,ASSR and behavioral audiometry in sound field for the identification of sensorineural losses in children.Methods In the study 48 children were divided as group PTA of the children assessed by pure tone audiometry and ABR and ASSR test,and group BA of the children unable to perform on behavioral evaluations.Results The analysis of the audiometric results of group PTA showed significant correlation between the ASSR thresholds and pure tone thresholds(P＜0.01) at various frequencies.The correlation coefficients were 0.75,0.76,0.76,and 0.83 at different frequencies.The ASSR-PTA linear regression was utilized.The comparison of the ABR and ASSR results of group BA indicated that 23 ears responded in ASSR but without responses in ABR.Those without ASSR responses also had no ABR There were 116 tests in total four frequencies for the 29 ears.83 responses were obtained from ASSR,89 responses from behavior audiometry and 96 from the use of the both tests.Conclusion The comprehensive audiologic evaluation battery could be used to test younger children with severe heating loss children as compared to the pure tone audiometry alone.More detailed data can be obtained thus from children to assist in rehabilitation in a more effective mariner.

Objective:To investigate the effects of nitric oxide(NO) and inducible nitric oxide synthase (iNOS) in the experimental abdominal aortic aneurysm (AAA) rat model.Methods:An intra-aortic elastase infusion model was used.Control rats received intra-aortic saline infusion.In the remaining groups,intra-aortic elastase infusion was used to induce aneurysm formation.These rats were treated with intraperitoneal injections of saline postoperatively(experimental group),aminoguanidine postoperatively(medicine group).Serum NO and aortic diameter were measured,Changes of histology,iNOS and MMP-9 were observed in the aortic wall.Results:Experimental group produced AAAs with significant production of iNOS,MMPs and serum NO compared with controls.In medicine group reduced aneurysm size and displayed suppression of MMPs expression,inflammatory infiltrates and serum NO production were detected.Conclusion:Expression of iNOS and MMP-9 are induced and serum NO levels are increased in experimental AAA,iNOS and NO production by iNOS play an important role with detrimental effects during experimental aneurysm development.

Objective To detect the serum growth hormone(GH),insulin-like growth factor-I(IGF-Ⅰ),insulin-like growth factor binging protein-3(IGFBP-3) levels in children with hypothyroidism and explore the change regulation of GH-IGF axis and thyroxine.Methods Fifty-six hypothyroidism children were divided into congonital hypothyroidism(CH)(14 cases) and Hashimoto's thyroiditis(32 cases).Serum GH,IGF-Ⅰ,IGFBP-3 levels of 56 hypothyroidism children before and after luothyroxine sodium L-T4 treatment and 50 normal children were detected with radioimmunoassay or enzyme-linked immunosorbent assay methods.Results Serum IGF-I,IGFBP-3 levels in 9 CH newborn group were lower,and they were normal after thyroxine substitute therapy.But those of 5 children with CH and 32 cases with Hashimoto's thyroiditis were not significantly changed.Conclusions The GH-IGF axis is inordinate in the CH children,which is an important reason of stature short.Early thyroxine substitute therapy is very helpful to maintain normal growth and development of children with CH.

OBJECTIVETo verify the regulatory effects of acupuncture on exercise tolerance in patients with chronic obstructive pulmonary disease (COPD) at stable phase.

METHODSThirty cases of COPD were randomly divided into a treatment group (16 cases) and a placebo group (14 cases). Based on specified aerobic exercise, acupuncture was applied in the treatment group and placebo acupuncture was used in the placebo group. The acupoints included Danzhong (CV 17), Rugen (ST 18), Guanyuan (CV 4), Zhongwan (CV 12), Tianshu (ST 25) and so on. The needle did not penetrate into the skin for the placebo group. The treatment was required for 2 to 3 times per week for totally 5 weeks. The indices of exercise tolerance, including 6-min walking distance (6-MWD), exercise time, maximum oxygen uptake (VO2max) forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), maximum ventilatory volume (MVV), St. George respiratory questionnaire (SGRQ) were observed in two groups before and after treatment.

RESULTS(1) Exercise tolerance: the differences of 6-MWD and exercise time were statistically significant between groups, which were more superior in the treatment group (both P<0.01); the VO2max was significantly increased after treatment in the treatment group (P<0.05), but there was no difference between two groups (P>0.05). (2) Pulmonary ventilation function: the differences of FEV1%, FEV1/FVC and MVV% were statistically significant between groups, which were more superior in the treatment group (P<0.05, P<0.01); (3) SGRQ: the SGRQ was significantly improved after treatment in the treatment group (P<0.05), but there was no difference between two groups (P>0.05).

CONCLUSIONThe acupuncture could improve the exercise tolerance in patients with chronic obstructive pulmonary disease at stable phase, and shorten the onset time of aerobic exercise. Besides, acupuncture combined with aerobic exercise could effectively improve the pulmonary function.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Exercise Tolerance ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; therapy

OBJECTIVE: To explore the effect of masking therapy for the early stage of the patients with noise-induced tinnitus,and imply the treatment for patients with noise-induced tinnitus. METHOD: Sixty-eight cases with tinnitus were studied. All the patients took the audiological examinations and tinnitus tests firstly, and accepted the masking therapy for 6 months. The therapeutic effiency was evaluated according to tinnitus handicap inventory (THI) and subjective visual-analogue scale (VAS). The minimum masking intensity was also evaluated. RESULT: The majority of the patients with noise-induced tinnitus (59 cases, 86. 8%) had tinnitus frequency of 4 kHz,and most of them (44 cases, 64. 7%) had positive residual inhibition tests. Tinnitus completely disappeared in 3 cases after masking therapy, and the efficiency of this treatment is 83. 8%. There was significant difference in the scores of THI and VAS before and after therapy(P<0. 01), and there was also significant difference in the minimum masking intensity (P<0. 01). CONCLUSION Masking therapy is the most important treatment for the patients in the early stage of noise-induced tinnitus. The therapeutic effiency is significant and should be promoted.
Humans ; Noise ; adverse effects ; Tinnitus ; etiology ; therapy

OBJECTIVE: To analyze and summarize nystagmus of patients with posterior canal benign paroxysmal positional vertigo (BPPV) in positioning test,and to improve the diagnosis and treatment of posterior canal BPPV (PSC-BPPV). METHOD: The present study was conducted on 175 patients who had unilateral BPPV of the posterior semicircular canal (PSC). Their positional nystagmus recorded by videnonystagmography in Dix-Hallpike test,roll test and roll over test were analyzed to summarize the characteristics of nystagmus on nystagmograph of PSC-BP-PV. RESULT: Of the 175 patients, lesion was located in the left PSC in 69 (39.4%) patients,the right PSC in 106 (60. 6%)patients. The nystagmus of patients with PSC-canalithiasis showed upward on the vertical phase of nystagmograph and orientated the different side on horizontal phase in the head hangging position. The horizontal phase pointed to the contralateral side in 47(26. 9%) patients, the ipsilateral contralateral side in 100(57. 1%) patients,no significant reverse ingredients in 28(16.0%) patients. When these patients returned to sit,139(79.4%) patients showed down beating positioning nystagmus, whereas 36 (20. 6%) patients with no nystagmus only had a short vertigo or dizziness. The horizontal phase of the 139 patients pointed to the contralateral side in 40(22. 9%) patients,the ipsilateral contralateral side in 68(38. 9%) patients,no significant reverse ingredients in 31(17. 7%) patients. In roll test,12 patients of the right PSC-BPPV presented an up-beating rotatory nystagmus when the head turned to right,and 5 patients of the left PSC-BPPV presented a down-beating rotatory nystagmus when the head turned to left. When the patients changed body from the left lateral position to the right lateral position in the roll over test, 74(42. 3%) patientsshowed vertical positioning nystagmus. In 30 patients who presented an up-beating nystagmus, there were 25(83. 3%) patientscame from the right PSC-BPPV. In 44 patients who presented a down-beating nystagmus, there were 36(81. 8%) patientscame from the left PSC-BPPV. The direction of the vertical nystagmus was highly correlated with the judgment about the side of the PSC-BPPV in roll over test (P<0. 01). CONCLUSION The patient with PSC-canalithiasis showed an uncertain direction in torsional nystagmus in Dix-Hallpike test,the diagnosis was mainly concern with the vertical nystagmus. When we found a rotatory nystagmus with much more up-beating nystagmus in roll test, it might be PSC-BPPV. We also can use the roll over test to diagnose the location of the otolith in which side of the PSC-BPPV.
Benign Paroxysmal Positional Vertigo ; complications ; Dizziness ; Electronystagmography ; Face ; Head ; Humans ; Nystagmus, Physiologic ; Otolithic Membrane ; Patient Positioning ; Semicircular Canals ; Vertigo ; Vestibular Function Tests

Objective To investigate the causes and managements of dys-seal syndrome (DSS) developed after esophageal stent placement. Methods From June 2001 to June 2008, esophageal stenting was performed in 98 consecutive patients with malignant esophageal obstruction. A total of 99 metallic stents were used. Of 98 patients. gastroesophageal anastomosis stricture was seen in 19, preoperative radiotherapy history in 26 and tracheoesophageal fistula in 34. Results DSS occurred in 7 patients, with an occurrence rate of 7.14% ,which was significant higher than that in patients with preoperative radiotherapy history and in patients showing marked dilated esophagus proximal to the obstructed site (X~2=0.017, 0.005, P=0.036, 0.013, respectively). After treatment, such as fasting, IPN or nasogastric feeding,only 1 case retumed to semi-liquid diet. Among the rest 6 cases of DSS, an additional stent was employed in one (but in vain), nasogastric feeding tube was used in 2, and removal of the stent under endoscopic guidance was carried out in 3. Conclusion DSS is one of the complications developed after esophageal stent placement, its prognosis is rather poor. Removal of the inserted stent may be the optimal treatment. The prevention of DSS includes proper pre-operation evaluation, selection of suitable stent, enhancement of perioperative nutritional support, etc.

Objective To evaluate the efficacy of Fluency stent-graft (Bard Corp) in transjugular intrahcpatic portosystemic shunt (TIPS).Methods The clinical data of 21 consecutive patients treated by TIPS using Fluency stent-grafts were retrospectively reviewed.All of them were recurrent variceal bleeding secondary to portal vein hypertension,1 was bleeding secondary to primary hepatic carcinoma with port vein thrombns,and 1 was Budd-Chiari syndrome.They were followed-up after (10.1 ± 4.6) months (2.0 to 24.0 months).Stent-grafts patancy,portal vein pressure and liver function were recorded and compared.Results Twenty-five stent-grafts were successfully implanted in 21 patients,23 stent grafts were 8 mm 2 were 10 mm in diameter.The covered length of the stents varied from 6 to 8 cm.The bleeding was stopped and the portal vein pressure decreased significantly from (25.4 ± 3.5) mm Hg to (15.4 ± 2.8) mm Hg (t = 12.495,P < 0.01).During the follow-up period,The patient with primary HCC and portal vein thrombosis died 4 months after the procedure. One case had a new primary HCC during the follow-up and died 24 months after the procedure.One ease with variceal bleeding secondary to portal vein hypertension died of muhisystem organ failure.One case occluded in the hepatic vein and had another stcnt graft implanation.The other 17 cases had no stenosis after 7 to 17 months follow-up.Ultrasound showed that the stents were patent 1 week before the patients died.Three cases had transient symptoms of hepatic encephalopathy and recovered after treatment.The Child scores of the 19 patients survived more than 6 months were 6.3 ±1.4 before and 6.4 ± 1.9 after the procedure without significant difference (t = 0.645,P > 0.05).Conclusion The Fluency stent-grafts could increase the patency of the TIPS,but its efficacy on the long-term effect and hepatic encephalopathy need further investigation.

Objective To investigate audiological characteristics of patients with intact tympanic membranes and conductive or mixed hearing loss .Methods A retrospective study was carried out among 30 patients (42 ears) with intact tympanic membranes and conductive or mixed hearing loss who underwent exploratory tympanotomy . The preoperative outcomes of pure tone audiometry ,tympanometry ,resonant frequency of middle ear and temporal bone CT scan were analyzed .Results Among 42 ears ,30 ears with otosclerosis and 12 ears with ossicular chain dis-ruption were confirmed in exploratory tympanotomy ,but only 5 ears showed positive findings in CT scan .The mean thresholds of bone conduction ,air conduction and air -bone gap at frequencies of 0 .5 ,1 and 2 kHz were 27 .5 ± 1 .3 dB HL ,67 .0 ± 1 .8 dB HL ,39 .5 ± 1 .1 dB HL ,respectively .An analysis of tympanometric data of all patients re-vealed that 50% of all ears (21/42) were type A tympanograms ,42 .9% (18/42) were type As tympanograms ,and 7 .1% (3/42) were type Ad tympanograms .The mean of the resonant frequency of the middle ear in otosclerositic patients (1 079 .0 ± 67 .4 Hz) was significantly higher than ossicular chain disruption patients (633 .3 ± 43 .6 Hz) . Conclusion Otosclerosis is the most common in the patients with intact tympanic membranes and conductive or mixed hearing loss .The middle ear resonant frequency of otosclerositic patients is significantly higher than that of ossicular chain disruption patients .