Objective To investigate the predictive value of symmetrical ambulatory arterial stiffness index (S-AASI) in detecting early renal impairment of patients with essential hypertension.Methods Totally 245 consecutive out-patients were confirmed with essential hypertension,and were divided into group A (56 cases),group B (64 cases),group C (72 cases),and group D (53 cases) according to the quartile of S-AASI.The combination testing of serum cystatin C,serum β2-microglobulin as well as urine microalbumin to creatinine ratio were implemented as laboratory diagnosis index of renal impairment in early stage and 109 essential hypertension patients were diagnosed with early renal impairment.The parameters were compared among 4 groups.Pearson correlation analysis and partial correlation analysis were performed to confirm the relationship between the markers of early renal impairment and S-AASI.The predictive value of S-AASI to detect early renal injury was evaluated by analyzing Receiver Operating Characteristic (ROC) curve.Results With the rising of S-AASI,age as well as 24 hours mean systolic blood pressure (24 h SBP),serum cystatin C,serum β2-microglobulin,urine microalbumin to creatinine ratio and the incidence rate of early renal injury went notably higher while estimated glomerular filtration rate (eGFR) decreased significantly.After controlling for age,correlation test showed S-AASI was positively correlated with24hSBP,serum cystatin C,serumβ2-microglobulin,urine microalbumin to creatinine ratio(r =0.392,0.627,0.514 and 0.643 respectively,P ＜ 0.05) and negatively correlated with eGFR(r =-0.312,P ＜ 0.05).The 24 hours mean diastolic blood pressure (24 h DBP) was uncorrelated with S-AASI.Area under ROC curve of S-AASI for diagnosis of hypertensive renal impairment was 0.885.The critical value of S-AA-SI was 0.17,the sensitivity,specificity,positive predictive value,and negative predictive value were 92.7％,65.2％,68.5％,and 91.7％,respectively.Conclusions When S-AASI was detected above 0.17,patients with hypertension had a higher risk of renal impairment.Higher S-AASI was correlated with worse early renal impairment laboratory indexes.The predictive accuracy of S-AASI for early hypertensive renal impairment was medium.

One hundred seventy of patients with cervical esophageal carcinoma (30 cases were treated by pre-operative radiation and surgery (combined group), 27 cases by surgery alone, 113 cases by radical radiation). The doses of the preoperative radiation and the radiacal radiation were D T40 Gy/4w and above D T 50 Gy/5w, respectively. The 5 year survival rates were 40% in the combined group, 15.3% in surgry alone, and 28% in radical radiation groups. The difference of survival rates in the combined group and surgery alone was significantly different statistically. Factors affecting the survivals were lymphnode metastasis in radical radiation and recurrent larygeal nerve paralysis in the combined group. The main causes of failure were local residual and recurrence (71%) in radical radiation and lymphnode metastasis (81%) in the combined group. The authors believe that pre-operative radiation combined with surgery could improve the survival of cervical esophageal carcinoma. Radical radiation is also one of effective treatment methods for cercical esophageal carcinoma.

Objective To study the anatomic characteristics of Zuckerkandl's tubercle (ZT) and its clinical relevance as an anatomic landmark of the recurrent laryngeal nerve (RLN) in thyroid surgery.Methods This study involved 147 (106 with benign thyroid diseases and 41 with malignancies) patients who underwent thyroidectomy.ZT was measured and classified based on the Pelizzo classification.The relationship between ZT and the RLN and the relationship between the RLN and the inferior thyroid artery were recognized and classified.Results 233 (107 left and 126 right) thyroid gland lobes were dissected and ZT was identified in most patients (left in 93.5％ and right in 96.0％).The distribution of ZT according to grade was as follows:Grade 0,left 16.0％ and right 13.2％ ; Grade Ⅰ,left 32.0％ and right 27.3％ ; Grade Ⅱ,left 46.0％ and right 44.6％ ; Grade Ⅲ,left 6.0％ and right 14.9％.There was no significant difference on classification between the left-sided and right-sided ZTs.In terms of the relationship between the ZT and the RLN,it was classified as follows:Type A,left 92.9％ and right 93.3％ ; Type B:left 0 and right 0; Type C:left 7.1％ and right 6.7％.Similarly,there was no significant difference between the left sided and the right sided.The ZT grade was correlated with the course of the RLN:the higher the ZT grade was (that is,the greater the size of the ZT),the more often was the course of RLN behind the back of the ZT; the lower the ZT grade (that is,the smaller the size of the ZT),the more often was the course of RLN running by the lateral of the ZT.Considering the incidence of being dangerous type of RLN,the right sided (19.0％) was higher than the left sided (8.3％).The relationship between the ZT and the RLN does not relate to RLN course across the inferior thyroid artery.Conclusions As an important anatomic landmark,the ZT is essential for locating and dissecting the RLN during thyroid surgery,and its classification is a guide to RLN dissection and preservation.

Objetive To investigate a method of collecting lung cancer cells with bronchofibroscopic biopsy for primary culture and to improve the success rate of primary culture. Methods Thirty lung cancer specimens were obtained through bronchoscopic biopsy for primary culture. The correlation of cancer morphology under bronchofi-broscopy and success rate of primary culture was analyzed. Results Among the lung cancer specimens obtained through bronchoscopic biopsy, primary culture was successful in 17 of 30 cases (56.67%) . The success rate of cauliflower-like tumor mass under bronchofibroscopy was 84.62% (11/13) . The success rate of infiltrating tumor mass under bronchial mucosa with luminal stenosis with or without cristate were 66.67% (2/3) and 37.5%(3/8), respectively. The primary culture of a globular and stiff tumor mass was successful only 1 in 6 cases (16.67%) .Conclusions The primary culture of lung cancer cells obtained from bronchofibroscopic biopsy is simple and effective with a total success rate of 56.67%. Furthermore, the success rate of primary culture is signifi-cantly correlated with the cancer morphology under bronchofibroscopy.

OBJECTIVE:To probe into the effects of carrying out"Prescription Set"self-help service in cooperative medical care clinic service in countryside in lessening the economical burden of peasants patients and enabling more people benefited from the basic health care.METHODS:Targeting at the common diseases in clinic service of the health center,for each of which at least3kinds of treatment plans prescription in different prices were worked out,to make the peasants patients choose the prescription freely.RESULTS&CONCLUSION:The outpatient number has increased significantly while medical expenses on prescriptions of outpatients decreased significantly in the primary level hospitals and community clinics through the practice of"Prescription Set"self-help service.

ObjectiveTo evaluate the efficacy of sphenopalatine ganglion stimulation with acupuncture for moderate-to-severe perennial allergic rhinitis.MethodsA total of 50 patients were recruited into a sphenopalatine ganglion stimulation group and a routine acupuncture group according to order of presentation, with 25 in each group. The sphenopalatine ganglion stimulation group received sphenopalatine ganglion stimulation with filiform needle, 1-2 sessions/week for 4 weeks. The routine acupuncture group received traditional acupuncture, withyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the maln points, andyingxiang(LI 20),yintang(GV29),fengchi(GB20),fengfu(GB16),zusanli(ST36) as the adjunct points, 1-2 points from both the maln and adjunct points in each session, 2 sessions/week for 4 weeks. The nasal symptom score (2004 version), the total nasal symptom score (TNSS) and the total non-nasal symptom score (TNNSS) were used to evaluate symptom improvement. The Rhinoconjunctivitis Quality of Life Questionnalre (RQLQ) was used to assess the patients’ quality of life. The time to symptom alleviation, duration of symptom alleviation in every session and the recurrence duration during 1 month after the treatment were compared between the two groups.Results After the treatment, the score of the nasal symptom score (99.74 ± 31.89vs.196.83 ± 31.22;t=-4.912,P=0.001), TNSS (33.63 ± 12.37vs.71.82 ± 19.21;t=-3.463,P=0.003), TNNSS (33.63 ± 12.37vs.71.82 ± 19.21,t=-3.463,P=0.003) in the sphenopalatine ganglion stimulation were significant lower than those in the routine acupuncture group. Compared with the routine acupuncture group, the time to symptom alleviation was significant shorter (13.85 ± 4.21 minvs.45.63 ± 7.87 min;t=-1.763,P=0.008), while the duration of symptom alleviation was significant longer (37.92 ± 9.94 hvs.3.35 ± 1.23 h;t=7.637,P<0.01) after each session in the sphenopalatine ganglion stimulation group. Four weeks after the treatment, RQLQ score in the sphenopalatine ganglion stimulation group was significant lower than that in the routine acupuncture group (8.48 ± 3.71vs.37.68 ± 12.46;F=-7.312,P<0.01). The recurrence duration during 1 month after the treatment in the sphenopalatine ganglion stimulation group was significant longer than that in the routine acupuncture group (4.12 ± 2.15 dvs.23.53 ± 4.63 d;t=-8.879,P=0.003).ConclusionSphenopalatine Ganglion stimulation is superior to routine acupuncture in treatment of patients with moderate-to-severe perennial allergic rhinitis.

OBJECTIVETo investigate the clinical features and proline-rich transmembrane protein 2 (PRRT2) gene mutation in patients with paroxysmal kinesigenic dyskinesia (PKD).

METHODClinical information was collected at Peking University First Hospital from January 2004 to July 2014. In total, 10 patients with PKD were recruited, and all were males. Among them, four patients were the probands from four PKD families and the other six patients were sporadic cases. Clinical information was analyzed. Peripheral blood samples for DNA study were collected from PKD patients and their family members. Genomic DNA was extracted using standard procedures. Mutation analysis of PRRT2 was performed by Sanger sequencing after PCR.

RESULTOf the 10 patients, the median age of dyskinesias onset was 10 years, ranging from 4 to 13 years. The description of their attacks were abnormal involuntary movements provoked by sudden movements, without loss of consciousness. Five patients exhibited dystonia, two patients exhibited choreoathetosis, and three patients had mixed (dystonia and choreoathetosis) dyskinesias. The duration of the attacks lasted for 3 to 30 seconds. The frequency ranged from once per month to twenty times per day. PRRT2 mutations, c. 649_650insC (p. R217PfsX8), were found in all the four PKD families. Mutation c. 649_650insC was also detected in two of the six sporadic PKD cases, inheriting from their asymptomatic mother.

CONCLUSIONThe onset age of PKD could be in the early childhood. The clinical features of the familial cases and sporadic cases showed no difference. The attacks manifested as dystonia, choreathetosis, or mixed. PRR2 mutations could be identified in familial or sporadic cases with PKD. Mutation c. 649_650insC is the hotspot mutation of PRRT2 gene.

Adolescent ; Child ; Child, Preschool ; DNA Mutational Analysis ; Dystonia ; genetics ; Humans ; Male ; Membrane Proteins ; genetics ; Mutation ; Nerve Tissue Proteins ; genetics

The effects of hypoxia on the expression of Fos was studied in the distal cerebrospinal fluid contacting neurons (CSF-CNs) in the dorsal raphe nucleus (DR) of the rat. The hypoxic models mimic 8000 m high level were established in a high-altitude decompression chamber. Injecting the tracer of CB ( chorela toxin B subunit) into the rat's lateral ventricles, we investigated the distribution of the distal CSF-CNs in the DR. The single and double immunohistochemistry staining with antibodies to Fos and CB were used to observe the expression of Fos in the distal CSF-CNs in the DR. The results showed that a large number of CB-like immunoreactive (-LI) neurons (31.16 ±3.36/per section) were located in the DR. In hypoxic experimental rats, the number of Fos-LI neurons was increased sharply (40.28 ±2.17/per section, P ＜0.05 compared to control rats), and a few CB/Fos-LI neurons (2.00 ±0.39/per section) could be observed in the DR. In control rats, several Fos-LI neurons (5.55 ±0.81/per section) and no CB/Fos-LI neuron could be observed in the DR. These results suggest that some of the distal CSF-CNs in the DR may play roles in transmitting information between brain and cerebrospinal fluid and modulating the function of brain following hypoxic stimulation.

Objective To investigate the curative effect of damage control theory in treating severe polytrauma patients combined with bone and joint injury. Methods A retrospective study was done on data including complication, death rate, fracture healing and joint function recovery of 63 patients with severe polytrauma combined with bone and joint injury( average ISS ≥27 points) admitted to our hospital from January 2006 to June 2009. Results Of all the patients, 57 shock patients were cured,three died of hemorrhagic shock within two hours after admission and one patient died of severe traumatic brain injury 11 hours after admission. One patient died of ARDS at 24 hours postoperatively and one died of multiple organ failure at day 6 after injury. Fracture healing was achieved in 52 patients, with satisfactory recovery of the limb function. Amputation was performed in two patients and three patients had mild claudication and pain walking. Conclusion Damage control strategy has great clinical significance in guidance of treatment of severe polytrauma combined with bone and joint injury.

Objective To investigate the clinical characteristics of cervical spine injury associated with chest injury by contrast with simple cervical spine injury.Methods A retrospective analysis was performed on records of 116 patients with cervical spine injury hospitalized from March 2009 to September 2014.There were 65 patients with simple cervical spine injury (simple injury group) and 51 patients with associated chest injury (associated injury group).Data recorded were the causes of injury, injury segment, treatment choices (tracheotomy rate, mechanical ventilation use and non-operative treatment), treatment time (operation rate at different time, time from injury to operation and length of hospital stay) , complications (electrolyte disorder, respiratory infection, respiratory dysfunction or failure, urinary tract infection, gastrointestinal bleeding and multiple organ dysfunction syndrome), and treatment outcome.Results The main cause of injury for the two groups was high falling.Lower cervical segment was the most likely to be affected.Significant differences were detected between the simple injury group and associated injury group with regard to tracheotomy rate (63％ vs.42％), rate of mechanical ventilation (41％ vs.25％), rate of early surgery (29％ vs.58％), rate of delayed surgery (69％ vs.30％), time from injury to operation [(7.2 ± 3.7) d vs.(3.1 ± 1.3) d], length of hospital stay [(22.6-± 5.5) d vs.(17.3 ± 3.7)d], electrolyte disorder rate (35％ vs.17％), incidence of respiratory system infection (55％ vs.35％), and respiratory dysfunction (43％ vs.25％) (P ＜0.05).After treatment, American Spinal Injury Association (ASIA) scale for grade D was significantly lower in associated injury group than in simple injury group (25％ vs.39％ P ＜ 0.05).Conclusion Cervical spine injury associated with chest injury is severe injury, often requiring tracheotomy and mechanical ventilation, and demonstrates difficulties to be effectively treated in the early phase, long hospitalization, various complications and high morbidity.