Objective To investigate the feature of CT perfusion of the lower limb skeletal muscle in patients with diabetic peripheral arterial disease (PAD).Methods It was a prospective study that collected out-patients and in-patients of interventional vascular surgery from January 2008 to January 2013.The patients were divided into three groups,including 27 patients (54 limbs) in diabetic PAD group,27 patients (54 limbs) in common PAD group and 9 patients (18 limbs) in control group.Patients in diabetic PAD group were selected when PAD were diagnosed through CTA and patient had the exact history of diabetes.There were 54 limbs in diabetic PAD group,including 10 limbs in Fontaine Ⅰ class,21 limbs in Fontaine Ⅱ class,14 limbs in Fontaine Ⅲ class and 9 limbs in Fontaine Ⅳ class.Patients in common PAD group were selected when PAD were diagnosed through CTA,patients those had the exact history of diabetes or coronary heart disease were exclusion.Patients in control group were collected with negative CTA results.CT perfusion scans of lower extremities were performed in all patients.Time density curve (TDC),Blood flow (BF),blood volume (BV),mean transit time (MMT) and permeability surface (PS) of skeletal muscle in different pathologic stage were obtained with perfusion software.The differences of perfusion parameters among diabetic PAD group,common PAD group and control group were compared by analysis of variance; and the differences of perfusion parameters among control group and all Fontaine classes in diabetic PAD group were also compared.Results TDC of normal skeletal muscle in control group continued to rise,and raise rapidly at an early stage; TDC of diabetic PAD group and common PAD group continued to rise,but raise slowly; the TDC of ischemia skeletal muscle has smaller slope and lower peak value than that of control group.The values of BF were (10.41±0.92) ml · 100 ml-1 · min-1 in control group,(13.37± 1.15) ml · 100 ml-1 · min-1 in diabetic PAD group and (17.12 ±0.81)ml· 100 ml-1· min-1in common PAD group.The values of BV were (1.04± 0.13)ml/L in control group,(1.23 ±0.16)ml/L in diabetic PAD group and (1.84 ±0.23) ml/L in common PAD group.The values of MTT were (11.63 ± 1.45) s in control group,(7.92±0.35) s in diabetic PAD group and (7.82±0.38) s in common PAD group.The values of PS were (3.46±0.84) ml· 100 ml 1· min-1 in control group,(9.84±0.87) ml· 100 ml-1· min-1 in diabetic PAD group and (12.11 ±0.70)ml· 100 ml-1· min-1in common PAD group.The differences of the values of BF,BV,MTT and PS among the three groups were statistically significant (F values were 10.892,4.492,27.543 and 20.506,P all＜0.05).The differences of the values of BF,BV among control group and all Fontaine classes in diabetic PAD group were not statistically significant(P all＞0.05),the differences of the values of MTT,PS were statistically significant.And the differences of the values of MTT,PS between control group and each Fontaine class in diabetic PAD were statistically significant (P all＜0.05).Conclusions CT perfusion imaging of Lower extremity skeletal muscle can prompt the existence of early skeletal muscle ischemia for diabetic PAD.The method can be valuable for clinical early diagnosis.

Objective To explore the effects of upper limb robot-assisted therapy on motor recovery in acute stroke patients. Methods From August, 2013 to September, 2014, 46 acute stroke patients at their first-ever stroke were enrolled and randomized into experimental group and control group with 23 cases in each group. Both groups received routine therapy. Additional robot-assisted therapy was provided to the experimental group, and additional repetitive movement training was provided to the control group, 30 minutes a day, 5 days a week for 12 weeks. Fugl-Meyer Assessment-Upper Limb (FM-UL), modified Ashworth Scale (MAS) and modified Barthel index (MBI) were used to assess the motor function of the upper limbs and hands, the muscular tension of elbow, and activities of daily living (ADL) before and after treatment. Results After treatment, the scores of FM-UA, MAS and MBI improved in both groups (t>3.856, Z>1.889, P<0.05), and the scores of FM-UA and MAS were better in the experiment group than in the control group (t=-2.386, Z=-2.625, P<0.05), however, there was no significant difference in the score of MBI between two groups (t=-1.326, P=0.098). Conclusion Upper limb robot-assisted therapy can facilitate the recovery of the motor function of upper limbs in acute stroke patient.

Objective To compare the effectiveness and safety of radiofrenquency ablation(RFA) with other therapeutic methods for patients with early hepatocelluar carcinoma(HCC). Methods Randomized clinical trials(RCTs)which compared the efficacy or safety of RFA with other therapeutic methods for primary hepatocellular carcinoma in Cochrane library,EMBASE,PubMed,OVID and CBM were searched.Trials were considered of high quality if methodological quality score was 3 or more according to Jadad standard.Statistical heterogeneity between trials was evaluated bv STATA 9.0 and considered to exist when P＜0.1.Heterogeneity of the included articles was tested and used to select proper effective model for calculation.Sensitivity analysis was performed and publication bias was investigated through visual inspection of funnel plots and Egger regression model.Results Six RCTs including 862 cases were analyzed.As compared with other therapeutic approaches,RFA significandy increased 3-year overall survival rate and reduced local recurrence rate of early hepatocelluar carcinoma:the total OR were 2.06(95%CI being 1.54-2.77,P=0.000)and 0.40(95%CI being 0.28-0.57,P=0.000)respectively.As compared with other therapeutic approaches,the total OR of new HCC recurrence rates,extrahepatic metastasis rate and major complications in patients with HCC treated with RFA were 0.92 (95%CI being 0.68-1.24),0.98(95%CI being 0.30-3.22),1.35(95%CI being 0.49-3.77)respectively,showing no significant differences(P＞0.05).Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias(P=0.670,0.160,0.884,0.087,0.317,respectively,by Egger regression model).Conclusions RFA is superior to other treatment methods with respect to local recurrence and 3 year overall survival in early HCC and is the preferred tberapeutic method for small HCC because it is minimally invasive,simple and convenient.

Objective To pool the data of studies and evaluate the efficacy and safety of TNFα blocking agents in the treatment of ulcerative colitis(UC).Methods The randomized clinical trials(RCT)that compared the efficacy or safety of TNFα in the treatment of UC were researched from Pubmed. OVID. EMBASE. Cochrane library, CNKI, Wanfang data and VIP Chinese Scientific and Technologic Periodical Database. Statistical heterogeneity between trials was evaluated by Revman 5.0 and was considered to exist when P＜0.1.Heterogeneity of the included articles was tested. which was used to select proper effect model to calculate. Publication bias was investigated through visual inspection of funnel plots. Results Nine RCT including 1226 cases were analyzed. Eight hundred and six cases had received TNFα treatment and 420cases had received placebo or glucocorticoid treatment. Compared with placebo or glucocorticoid groups, TNFα group achieved significantly higher rates of short-term clinical response, short-term clinical remission, long-term clinical response.10ng-term clinical remission and the total OR were 2.36(95%C,1.34-4.15),2.42(95%CI 1.22-4.81).3.22(95%CI2.28-4.55)and 2.82(95%CI1.91-4.16)respectively. TNFα group was less likely to undergo colectomy than placebo group and the total OR was 0.31(95%CI0.20-0.48).TNFα could not improve the mucosal healing and quality of lire. No significant difference was found in adverse effect between TNFα group and placebo or glueoeortieoid group(OR=1.07(95%CI0.55-2.09,P=0.84)).The rate of serious adverse effect in TNFα group was less than placebo or glueoeorticoid groups (OR=0.65,95%CI0.48-0.89,P=0.007).Inspection of the funnel plots for all dichotomous data measures had not revealed evidence of publication bias. Conclusions Patients with moderately to severely active UC treated with TNFαhave effective clinical response and clinical remission and are less likely to undergo colectomy than those receiving placebo or glucocorticoid. TNFα treatment is safe for UC but can not improve the mucosal healing and quality of life. Large-scale, high-quality RCTs ale needed to confirm or refuse the available evidence.

Objective:To explore the directed forgetting ability of elder people to disease/death-related words under the conditions of the neutral and negative emotion.Methods:Thirty-six elder people and thirty-seven young people were included in this study.The directed forgetting effects to disease/death-related words were compared by using item-method directed forgetting paradigm under the neutral and negative emotional conditions.Results:Under the neutral and negative emotion conditions,higher recognition of to-be-remembered (TBR) than to-be-forgotten (TBF) words in elder group and younger group (Ps ＜ 0.05).The elder group showed the weaker effect of directed forgetting than younger group[neutral emotion:(0.4 ± 0.1) vs.(0.6 ± 0.1);negative emotion:(0.3 ± 0.1) vs.(0.7 ± 0.04),Ps ＜ 0.05].Under the negative emotion condition,elder people showed stronger effect of directed forgetting for sensitive words compared with control words[(0.4 ± 0.1) vs.(0.1 ± 0.1),P ＜ 0.001].Conclusion:The results suggest that the directed forgetting ability of elderly is weaker than that of young individuals,the ability of non-sensitive words than that with sensitive words,and the directed forgetting effect of elder people tonon-sensitive words in negative emotion is weaker than that in neutral emotion.

Objective To put forward the prevention advice on foreign body suction,and to discuss the effica-cy,safety and application experience of flexible bronchoscopy in the diagnosis and treatment of tracheobronchial foreign bodies in children. Methods The treatment experience of 38 cases for airway foreign body removal with flexible bron-choscopy and granulation tissue proliferation in Argon plasma coagulation ( APC ) ( argon knife ) combining carbon dioxide( CO2 ) cryotherapy in Bayi Children′s Hospital Affiliated to General Hospital of Beijing Military Command from January 2013 to December 2014 were reviewed,and the clinical data including age,gender,treatment time for inhaled foreign body,clinical and X-ray manifestations,location of the foreign body,treatment with bronchoscopy with APC and cryotherapy,complications and outcomes were analyzed. Results There were 38 cases of patients including 31 male (81. 6%) and 7 female(18. 4%),aged from 10 months to 14 years old,with mean age 28. 5 months;among them there were 30 cases with definite history of foreign body,accounting for 78. 9%;the most common clinical symptom was cough among the cases,accounting for 84. 3%;X ray showed 15 cases with ipsilateral lung atelectasis,accounting for 39. 5%, emphysema in 17 cases,accounting for 44. 7%,pneumonia change in 6 cases,accounting for 15. 8%,there were 11 ca-ses who had lung computerized tomography examination when coming to the hospital,and only 1 case could be seen to have foreign body shadow;microscopic examination found that inhaled foreign body in the right bronchus accounted for 57. 9%,and peanut was the main foreign body inhalation in this group;only 4 cases(10. 5%) had definite diagnosis and foreign body removal within 24 h after foreign body aspiration,moreover,34 cases(89. 5%) with foreign body aspi-ration got the diagnosis and treatment after 24 h;crying was the primary inducement for inhaled foreign body. All the 38 cases of children with inhaled foreign body experienced removal under flexible bronchoscopy. There were 19 cases (50. 0%) who had granulation tissue proliferation around the foreign body,among which 5 cases of foreign body was wrapped by the proliferation of granulation tissue,with APC dealing with the granulation tissue of foreign body surface to remove foreign body after exposure,then giving CO2 cryotherapy. Nevertheless,there were 9 cases of foreign body who had granulation tissue but was not wrapped,receiving CO2 cryotherapy directly after the foreign body removal. One case of this group had bradycardia during the surgery,and 2 cases had postoperative bleeding,but there was no death cases with foreign bodies removal. Conclusions Education is the key to prevent foreign body aspiration in infants under 3 years old. Flexible bronchoscopy is safe to remove foreign bodies from the respiratory tract and has fewer complications, so it is one of the alternative methods in diagnosis and treatment of foreign body inhalation.

Objective To explore the operating methods,the effectiveness and safety for 2 cases of tracheal in-tubation related severe subglottic stenosis under laryngeal mask by using bronchoscopy in the diagnosis and interven-tional treatment. Methods Two male patients ( age at 4 and 11 months) both had difficulty breathing and weaning failure after endotracheal intubation,who were diagnosed with severe subglottic stenosis through CT and bronchoscopy examination. All parents signed their consent after being fully informed of treatment risks. Two cases were treated under bronchoscopic holmium laser combined with argon plasma coagulation and freezing treatment by using the laryngeal mask. The clinical data, complications and postoperative outcome and follow-up were analyzed. Results Two cases were operated successfully,the subglottic granulation tissue of 1 case was completely removed,2 cases of patients had subglottic narrow annular completely removed, and there was no problem for 4. 0 mm bronchoscope to get through,postoperative tracheal catheter was successfully extracted,dyspnea was significantly improved. Two cases imme-diately showed well open after treatment,7 d,30 d and 90 d through endoscopic examination. During the operation,oxy-gen saturation decreased and heart rate increased fast or slowed down,but after operation and oxygen got resumed,they immediately recovered,and there were no abnormal hemodynamic changes during and after operation. The two cases were still under follow-up. Conclusions The laryngeal mask holmium laser,argon plasma coagulation and cryotherapy can be used to remove acquired granulation tissue hyperplasia caused by subglottic stenosis,which is safe and effective, and the short-term effect was remarkable. Long-term effect still needs to be further assessed through follow-up.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell ; pathology ; surgery ; Female ; Humans ; Kidney Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplastic Cells, Circulating ; pathology ; Nephrectomy ; methods

BACKGROUND: Early enteral nutrition (EEN) following liver transplantation can benefit to recover and guarantee the normal gastrointestinal tract function,which plays an important role on post-operational immunosuppressive therapy.OBJECTIVE: To conduct EEN on the patients undergoing liver transplantation,and observe the post-operation recovery of intestinal function.DESIGN: Case analysis.SETTING: The 81 Hospital of Chinese PLA.PARTICIPANTS: From April 2003 to June 2006,86 patients undergoing liver transplantation in Liver Transplantation Center at the 81 Hospital of Chinese PLA were enrolled,including 57 males and 29 females.They aged 21-68 years,with a mean of 48 years.Among them,there were 37 cases of primary hepatic carcinoma and 49 cases of posthepatitic cirrhosis; 8 cases graded in Child A (all hepatic carcinoma),34 cases in Child B,and 44 cases in Child C.And 5 cases were complicated with serious hepatitis liver function failure and hepatic coma.Informed consents were obtained from all the patients and relatives.Transplantation operation was approved by the hospital ethical committee.METHODS: Surgical approach was orthotopic liver transplantation through caval vein in 80 cases,typical orthotopie liver wansplantation without veno-venous bypass in 4 cases,and piggyback orthotopic liver transplantation in 2 cases.The average warm ischemia time was (4.8±2.4) minutes,and average cold ischemia time was (8.6±3.2) hours.Anhepatic phase was (84±28)minutes.Post-operational trigeminy immunity and anti-rejection therapy consisted of tacrolimus (Fujisawa product) +mycophenolate mofetil (Roche product) + prednisone (Pred).According to the presence of nasogastric feeding tube,the patients were divided into control group (n=49) and EEN group (n =37).There were no significant differences in the sex,age and general data of patients between the two groups.Control group adopted EEN mainly,while EEN group was fed with EEN via a nose-intestine nutritional tube,and they received short-peptide enteral nutrition (Pepti-2000) at 24 hours post-operation at the initial dose of 63-126 g/d,which was gradually increased to 372 g/d.Liquid diet was allowable by 3-5 days.MAIN OUTCOME MEASURES: ①Clinical recovery and complications of patients.②Liver function recovery indices such as total serum protein,albumin and prealbumin,as well as C reactive protein at days 1,3,5 post-operation.③Level of serum immune globulin at day 7 post-operation.RESULTS: Totally 86 patients were involved in the result analysis.①Clinical recovery and complications: In EEN group,abdominal distension occurred in 10 cases,diarrhea in 5 cases,and blocking or slippage of feeding tube in 3 cases; No emesia,back flow or aspirated pneumonia was found; In control group,2 cases appeared bile leakage,which was not detected in the EEN group.②Indices of liver function recovery: Compared with control group,the prealbumin level was significantly rised and C reactive protein was significantly decreased in the EEN group at days 3 and 5 (P ＜ 0.05).③Levels of serum immune globulin: Blood IgA and IgM of EEN group were significantly higher than those of control group at day 7 (P ＜ 0.05).CONCLUSION: EEN in post-operation patients can reduce stress,promote synthesize metabolism,improve the recovery of liver cells,and decrease the infection rate.

Objective To investigate the clinical and prognosis characteristics of SLE patients whose initial clinical presentations were Sj(o)gren's syndrome (SS).Methods Medical charts of 41 consecutive SS/SLE inpatients admitted to Peking Union Medical College Hospital (PUMCH) from February 1998 to February 2008 were systematically reviewed,including demographic data,clinical features,laboratory findings,treatment as well as prognosis.Two hundred and fourteen cases were randomly selected as controls from 2331 non SS-onset lupus (NSs/SLE) inpatients weated in PUMCH at the same time period.Results There were significant differences between SS/SLE and NSS/SLE patients in the following aspects (P＜0.05):①gender composition:(F/M) (41/0 vs 184/30),age at the diagnosis of SLE [(43±41) yrs vs (32±31) yrs)],disease duration L(114±84) mollths vs (45±18) months];②clinical features:xerostomia (85.3% vs 6.1%),xerophthalmia (75.6% vs 2.3%),faeial rash (9.8% vs 46.3%),renal tubular acidosis (21.9% vs 0),nephrotic syndrome (7.3% vs 31.3%),central nervous system invoivement (4.9% vs 19.6%),interstitial lung disease (12.2% vs 2.8%);③labratory findings:ESR[(65±75) mm/1 h vs (46±34) mm/1 h)],patients with elevated IgG level (56.4% vs 29.9%) and IgA level (38.5% vs 20.4%),RF,prevalence of anti-SSA and anti-SSB antibodies (70.8% vs 20.3%,82.9% vs 43.4% and 39.0% vs 7.9%);④SLEDAI score (8±8 vs 10±10),glucocorticosteroid treatment (methylprednisolone bolus/1～2 mg·kg-1·d-1 prednisone/1 mg·kg-1·d-1 prednisone)(8/26/7 vs 91/102/21),and rate of death and/or severe irreversible organ failure (2.4% vs 14.9%).SS/SLE patients were followed up for (33±34) months,40 cases remained stable and only one patient died of acute pulmonary embolism.Conclusion Compared to NSS/SLE,SS/SLE patients ale older and have more insidious disease course.They have higher prevalence rate of anti-SSA and anti-SSB antibodies,renal tubular acidosis and interstitial lung disease,but less severe neuropsychiatric and renal involvements and much better prognosis.