Objective To investigate the effects of mild hypothermia induced by endovascular cooling with heating exchange catheters on severe traumatic brain injury in patients. Methods Twenty patients with severe traumatic brain injury aged 18-60 yr were randomly divided into 2 groups (n=10 each):ice bay cooling group (group IBC) and endovascular cooling group (group EVC).The state of consciousness was scored on a Glasgow coma scale (GCS).The patients had GCS scores of 3-8. The patients underwent emergency surgery.A probe of intracranial pressure monitor was placed during operation.In group EVC intravascular heat exchange catheters were inserted via femoral vein and connected to intravascular heat exchange system (CoolGard 3000, Alsius, USA). In group EVC body temperature was reduced to 34℃ and maintained at this level for 48 h. MAP, HR, body temperature and intracranial pressure (ICP) were continuously monitored and cerebral perfusion pressure (CPP) was calculated. Blood samples were taken from peripheral vein for determination of serum concentrations of neuron specific enolase (NSE), myelin basic protein (MBP) and S-100B (by enzyme linked immunosorbent assay) and GCS scores were assessed at 10 min before (baseline) and 12, 24, 48 and 72 h after operation. The state of consciousness was again assessed 3 months after operation and scored on Glasgrow outcome scale(GOS). Results ICP was significantly lower and CPP was higher after operation in group EVC than in group IBC. Serum concentrations of NSE, MBP and S-100B were significantly lower after operation in group EVC than in group IBC. Conclusion Mild hypothermia induced by endovascular cooling with heating exchange catheters can effectively reduce severe traumatic brain injury in patients.

Purpose To observe the mutation of K-ras gene and expression of Fascin-1 protein in CRC tissues and their relationship with clinical pathological features, and then to analyze the correlation between mutation of K-ras and expression of Fascin-1. Methods In 86 cases of CRC tissues, K-ras mutation was detected by DNA sequencing analysis, and Fascin-1 expression was detected by im-munohistochemical method. Results In CRC tissues the mutation rate of K-ras was 34. 88%, the expression rate of Fascin-1 was 60. 47%. The mutation rate of K-ras in lymph node metastasis group was higher than that of without lymph node metastasis group, and that in distant metastasis group was higher than that of without distant metastasis group(P<0. 05). The expression rate of Fascin-1 in serosa invasion group was higher than that of without serosa invasion group, and that in lymph node metastasis group was higher than that of without lymph node metastasis group, and that in distant metastasis group was higher than that of without distant metastasis group (P<0. 01). There was a correlation between the mutation of K-ras gene and the expression of Fascin-1 in CRC tissues (rp =0. 236, P<0. 05). Conclusions The CRC tissues with mutation of K-ras are more likely to metastasize and the CRC tissues with expression of Fascin-1 are more likely to invade serosa and metastasize. The CRC tissues with mutation of K-ras are more likely to express Fascin-1.

Objective:To elucidate the correlation between peripheral blood levels of pentraxin 3 (PTX3) and fibroblast growth factors 2 (FGF2) and clinical manifestations, immunological indexes and disease activity of systemic lupus erythematosus (SLE) patients.Methods:The correlation between peripheral blood levels of PTX3 and FGF2 and clinical manifestations, immunological indexes and disease activity of SLE pa-tients was determined. T test, Mann-Whitney U test and Spearman's rank correlation coefficient were analyzed statistically. Results:Plasma PTX3 levels were significantly higher in SLE patients than in healthy controls (3 191±2 423) pg/ml vs (755±432) pg/ml, t=5.595, P<0.01) . The titer of PTX3 in patients with hematologic in-volvement was higher than that in the patients without [(3 810±2 840) pg/ml vs (2 493±1 830) pg/ml, t=2.008, P=0.049). Plasma PTX3 concentration in SLE patients was positively correlated not only with the level of 24 h urine protein ( r=0.498 6, P=0.005 9), but also with ESR ( r= 0.376, P=0.007) and systemic lupus erythematosus disease activity index (SLEDAI) scores ( r=0.405, P=0.003). On the contrast, plasma PTX3 concentration in SLE patients was negatively correlated with complement 3 ( r=-0.405, P=0.005). Increased serum PTX3 levels accompanied by increased serum FGF2 levels was observed. Plasma FGF2 concentration in SLE patients was positively correlated with SLEDAI scores ( r=0.326, P=0.019), but negatively correlated with level of comple-ment 3 ( r=-0.414, P=0.004) and complement 4 ( r=-0.451, P=0.007). Levels of FGF2 were higher in patients with positive anti-NuA antibody [(138±91) pg/ml vs (59±68) pg/ml, t=2.996, P=0.004 2), anti-dsDNA antibody [(120±96) pg/ml vs (56±58) pg/ml, t=3.583, P=0.000 7] and anti-rRNP antibody (151±109) pg/ml vs (63±61) pg/ml, t=3.757, P=0.000 4) than in patients with negative of these antibodies. Conclusion:The levels of PTX3 and FGF2 in peripheral blood may play a role in determining the disease activity and clinical phenotype of SLE, and can help doctors to make diagnosis and treatment decisions.

OBJECTIVETo evaluate the effect and safety of L-carnitine in the treatment of idiopathic oligoasthenozoospermia based on current clinical evidence.

METHODSWe searched the Cochrane Library, PubMed, MEDLINE, EMBASE, CNKI, VIP, CBM and Wanfang Database from the establishment to April 2014 for the published literature on the treatment of idiopathic oligoasthenozoospermia with L-carnitine. We conducted literature screening, data extraction, and assessment of the methodological quality of the included trials according to the inclusion and exclusion criteria, followed by statistical analysis with the RevMan 5. 2 software.

RESULTSSeven randomized controlled trials involving 751 patients with idiopathic oligoasthenozoospermia met the inclusion criteria, and 678 of them were included in the meta-analysis. L-carnitine treatment achieved a significantly increased rate of spontaneous pregnancy as compared with the control group (RR = 3.2, 95% CI 1.74 to 5.87, P = 0.0002). After 12-16 and 24-26 weeks of medication, total sperm motility (WMD = 5.21, 95% CI 2.78 to 7.64, P < 0.0001 and WMD = 9.29, 95% CI 1.28 to 17.29, P = 0.02) and the percentage of progressively motile sperm (WMD = 12.44, 95% CI 4.58 to 20.31, P = 0.002 and WMD = 9.76, 95% CI 3.56 to 15.97, P = 0.002) were remarkably higher than those in the control group, but no statistically significant differences were observed in sperm concentration between the two groups (WMD = 4.91, 95% CI -2.63 to 12.45, P = 0.2 and WMD = 0.93, 95% CI -3.48 to 5.34, P = 0.68). After 12-16 weeks of treatment, the percentage of morphologically abnormal sperm was markedly decreased in the L-carnitine group as compared with the control (WMD = -2.48, 95% CI -4.35 to -0.61, P = 0.009), but showed no significant difference from the latter group after 24-26 weeks (WMD = -4.38, 95% CI -9.66 to 0.89, P = 0.1). No statistically significant difference was found in the semen volume between the two groups after 12-16 or 24-26 weeks of medication (WMD = -0.13, 95% CI -0.43 to 0.18, P = 0.42 and WMD = 0.28, 95% CI -0.02 to 0.58, P = 0.07). No serious L-carnitine-related adverse events were reported in 4 of the randomniized controlled trials.

CONCLUSIONThe current evidence indicates that L-carnitine can improve spontaneous pregnancy and semen parameters in the treatment of idiopathic oligoasthenozoospermia, with no serious adverse reactions.

Asthenozoospermia ; drug therapy ; Carnitine ; adverse effects ; pharmacology ; Female ; Humans ; Male ; Pregnancy ; Pregnancy Rate ; Randomized Controlled Trials as Topic ; Semen Analysis ; Sperm Count ; Sperm Motility

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; instrumentation ; methods ; Male ; Middle Aged ; Radiography ; Spinal Osteophytosis ; diagnosis ; diagnostic imaging ; Young Adult

OBJECTIVE: To observe the effect of perioperative application of Sijunzi Decoction and enteral nutrition on T-cell subsets and nutritional status in patients with gastric cancer after operation. METHODS: In this prospective, single-blinded, controlled clinical trial, fifty-nine patients with gastric cancer were randomly divided into three groups: control group (n=20) and two study groups (group A, n=21; group B, n=18). Sjunzi Decoction (100 ml) was administered via nasogastric tube to the patients in the study group B from the second postoperation day to the 9th postoperation day. Patients in the two study groups were given an isocaloric and isonitrogonous enteral diet, which was started on the second day after operation, and continued for eight days. Patients in the control group were given an isocaloric and isonitrogonous parenteral diet for 9 days. All variables of nutritional status such as serum albumin (ALB), prealbumin (PA), transferrin (TRF) and T-cell subsets were measured one day before operation, and one day and 10 days after operation. RESULTS: All the nutritional variables and the levels of CD3(+), CD4(+), CD4(+)/CD8(+) were decreased significantly after operation. Ten days after operation, T-cell subsets and nutritional variables in the two study groups were increased as compare with the control group. The levels of ALB, TRF and T-cell subsets in the study group B were increased significantly as compared with the study group A (P<0.05). CONCLUSION: Enteral nutrition assisted with Sijunzi Decoction can positively improve and optimize cellular immune function and nutritional status in the patients with gastric cancer after operation.

Objective To observe effect of intra-and post-operative mild hypothermia using an ice blanket on patients with severe traumatic brain injury (sTBI).Methods Twenty sTBI patients with Glasgow Coma Scale (GCS) of 3-8 points were included and were assigned to either ice bag cooling (Bag group) or ice blanket cooling (Blanket group) (n =10 each) according to random number table.Patients in Bag group had temperature reduction by placing ice bag over great vessels,whereas in Blanket group an ice blanket (temperature was set as the nasopharyngeal temperature of 33℃-34℃) was employed to have temperature reduction.Hypothermia therapy in the two group groups was initiated from the beginning of operation and continued for 48 hours after operation.Intracranial pressure,cerebral perfusion pressure (CPP) and GCS in both groups were recorded respectively at 10 minutes before operation (T0) and at 8,12,24,48 and 72 hours after operation (T1,T2,T3,T4 and T5).Venous blood of the two groups was harvested to assay the serum concentration of neuronspecific enolase (NSE),myelin basic protein (MBP)and S-100β at T0,T3,T4,-Ts and at 96 hours after operation (T6) by ELISA method.Glasgow Outcome Scale (GOS) was evaluated at postoperative six months.Results In Bag group,body temperature (T1-T5) of the patients had no significant decrease (P ＞ 0.05) and NSE (T3-T6),S-100β (T3-T6) and MBP (T4-T6) were increased (P ＜ 0.05 or 0.01) when compared with those in T0 ; intracranial pressure (T2-T5) was increased (P ＜ 0.05) and CPP (T3-T5) was lowered (P ＜ 0.05) when compared with those in T1.In Blanket group,body temperature (T1-T6) of the patients presented was decreased significantly (P ＜ 0.01) and NSE (T3-T6),MBP (T5-T6) and S-100β (T4-T6) were increased (P ＜ 0.05 or 0.01) when compared those in T0 ; intracranial pressure (T2-T6) was increased (P ＜ 0.05) and CPP had no significant changes (P ＞0.05) when compared with those in T1.By contrast with those in the same time points in Bag group,lower body temperature (T1-T5) (P ＜ 0.001),lower intracranial pressure (T2-T5),higher CPP (T3-T5) as well as lower NSE (T4-T6),MBP (T4-T6) and S-100β(T6)were observed in Blanket group (P ＜0.05 or 0.01).Changes of GCS and GOS in the two groups were no significance (P ＞0.05).Conclusion Intraoperative and postoperative mild hypothermia therapy using an ice blanket may alleviate the degree of brain injury in sTBI patients.

A total of 1 100 patients underwent renal transplantation in the Organ Transplantation Center,Second Affiliated Department of General Hospital of Chinese PLA between 1988 and 2008 were collected,and retrospective analysis was performed in five female patients with malignant tumor,which appeared at 68 months (20-132 months) following renal transplantation,including 2 with renipelvic and uretal cancer and 3 with bladder cancer. Two of the 3 patients with bladder cancer presented homolateral renipelvic and uretal metastasis. Three cases and 1 case of upper uretal cacer were observed at the homolateral or heterolateral of kidney grafts respectively. The main characteristic of sign was iterative and painless gross hematuria. The 5 patients underwent renal transplantation with intravesical instillation therapy and nephrectomy. All patients were survived without rejection in the 1-62 months follow-up. The incidence of malignancy in renal allograft recipients is much higher than that in normal ones,which is related to the long term use of immunosuppressants. Urinary epithelial cancer is the main complicating carcinoma and the first choice of treatment is surgical operation. Based on the normal renal grafts function,the dose of immunosuppressants should be as low as possible,Moreover,radiotherapy or chemiotherapy should be adopted according to the types and stages of tumor complicating renal transplantation.

· Currently, refresher doctors’training is an important form of continuing medical education in our country, effectively promoting and improving the clinical ability and the service level of practitioners in basic -level medical organization. We combine ophthalmic professional features with refresher doctors’training in practice to explore ophthalmic continuing clinical training specifications.Training on the current status and new changes has been analyzed in order to further improve the training quality. The competent administrative departments and clinical teaching hospital should make full use of its advantages to institutionalize, specialize and standardize the training. We suggest linking the continuing clinical training with job promotion;strengthen core clinical ability and being strict with appraisal system so that after the training the trainees can spread standardized guidelines and technology, alleviating the current medical demand and the difficulties in the reform.

OBJECTIVETo evaluate the effect of insular pectoralis major myocutaneous flap on repair of jaw and neck tissue defect as a result of high-voltage electric burn.

METHODSEighteen patients with large area tissue defect in jaw and neck caused by high-voltage electric burn hospitalized from August 2001 to December 2007 were repaired with insular pectoralis major myocutaneous flap. The flaps (from 12 cm x 10 cm to 16 cm x 13 cm) was transplanted in 8 patients after early wound debridement, and in 10 patients on infected wounds.

RESULTSAll flaps survived wells except in 4 patients necrotic area (length 2-5 cm, width 1-2 cm) appeared in the distal wound edge, localized dehiscence of wound edge in 2 cases, which were healed after dressing change or secondary suturing. Patients were followed up from 6 months to 3 years, and the appearance and function were satisfactory.

CONCLUSIONSPectoralis major muscle island myocutaneous flap has the advantage of large tissue mass, with thin and flat muscle belly, and rich blood supply, which is suitable for repair of large deep tissue defect in jaw and neck.

Adolescent ; Adult ; Burns, Electric ; surgery ; Female ; Humans ; Middle Aged ; Muscle, Skeletal ; transplantation ; Neck ; surgery ; Skin Transplantation ; Surgical Flaps ; Young Adult