Objective:To study the effect of sertraline plus cognitive behavior therapy in treatment of panic disorder Method:14 outpatients with panic disorder according to crteria of CCMD-2-R were collected as our sample All of them were given sertraline 50 mg/d for 6 months in addition to cognitive behavior therapy The clinical effect was assessed at the end of 1 month,3 months and 6 months Results:At the end of 1 month,3 patients were assessed as markedly improved,9 as improved At the time of 3 months,10 patients were assessed as markedly improved,2 as improved At the end of 6 months,12 markedly improved,2 improved There were 3 patients had mild side effects,which faded with time Conclusion:Sertraline plus cognitive behavior therapy has good effect in treatment of panic disorder with good compliance and little side effect

0.05).In 25.28% of the population in the Second Songhua River region,the hair Hg content exceeded 1 mg/kg.In 21.85% and 16.67% of the population of Wujiazhan town and Songyuan city,the hair Hg content exceeded 1 mg/kg.Conclusion In the investigated area,the level of hair mercury shows a downtrend,but there still is health risk from mercury exposure.

OBJECTIVETo compare the difference in the clinical efficacy on post-stroke insomnia between the low-frequency electric stimulation at the acupoints and the conventional western medication.

METHODSOne hundred and twenty patients of post-stroke insomnia were randomized into a low-frequency electric stimulation group, a medication group and a placebo group, 40 cases in each one. In the low-frequency electric stimulation group, the low-frequency electric-pulsing apparatus was used at Dazhui (GV 14) and Shenshu (BL 23), once a day; the treatment of 15 days made one session and 2 sessions were required. In the medication group, estazolam was taken orally, 1 mg each time. In the placebo group, starch capsules were taken orally, 1 capsule each time. All the drugs were taken before sleep every night, continuously for 15 days as one session, and 2 sessions were required. PSQI changes and clinical efficacy were observed before and after treatment in each group.

RESULTSPitlsburgh sleep quality index (PSQI) score was reduced in every group after treatment (all P < 0.01). In the low-frequency electric stimulation group and medication group, the score was reduced much more significantly as compared with the placebo group (both P < 0.01). In the placebo group, 1 case was rejected. The total effective rates were 95.0% (38/40), 92.5% (37/40) and 17.9% (7/39) in the low-frequency electric stimulation group, medication group and placebo group separately. The efficacy in the low-frequency electric stimulation group and medication group was better apparently than that in the placebo group (both P < 0.01).

CONCLUSIONThe low-frequency electric stimulation at the acupoints effectively and safely treats post-stroke insomnia and the efficacy of it is similar to that of estazolam.

Acupuncture Points ; Aged ; Aged, 80 and over ; Electric Stimulation ; Female ; Humans ; Male ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; etiology ; therapy ; Stroke ; complications ; Treatment Outcome

OBJECTIVE:To prepare glycyrrhetic acid derivatives-modified norcantharidin(NC)liposome(GDNL)and study its liver-targeting property.METHODS:Gal-GAOSt targeting molecules were synthesized to modify NC and prepare GDNL,with the parameters such as the entrapment efficiency and particle diameter,etc.investigated.Mice were enrolled to be injected with GDNL and NC water solution,respectively via vena caudalis followed by determination of NC concentration in different tissues to compute the targeting-index(TI)of GDNL in liver.RESULTS:The prepared GDNL had an entrapment efficiency of 56.29%,particle diameter of(210?20)nm and TI of 5.213 in liver.CONCLUSION:The prepared GDNL has high entrapment efficiency and remarkable liver-targeting property.

Child ; Gene Rearrangement, T-Lymphocyte ; Humans ; Neoplasm, Residual ; diagnosis ; Polymerase Chain Reaction ; methods ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; diagnosis ; Receptors, Antigen, T-Cell ; genetics

Objective To evaluate the clinical outcome of lumbopelvic reconstruction in treatment of unstable sacral fractures.Methods A retrospective study was performed on 17 cases (12 males and 5 females； at 23-55 years of age,mean 35.5 years) of unstable sacral fractures treated from January 2007 to June 2012.There were 11 cases of zone Ⅱ fracture and six zone Ⅲ fracture according to Denis classification and nine cases of type B fracture and eight type C fracture according to Tile classification.Sacral nerve injury assessed by Gibbons criteria was 3 points in seven cases and 4 points in 10 cases.Lumbar-pelvic ring stability of the patients was restored by posterior decompression and lumbar pedicle screw fixation combined with sacral pedicle screw or iliac screw fixation.Fracture reduction and healing were measured by X-ray film or CT scan； functional outcomes by Majeed scale； neurological outcome by Gibbons criteria.Results All the cases were followed up for mean 16 months (range,8-24 months).X-ray and CT follow-up revealed all fractures had bone union at average 6 months in the absence of remnant sacrum malformation,pseudarthrosis and fracture redisplacement.Iliac screw loosening not yet breakage happened to one case.In total,12 cases had full recovery of neurological function； four significant improvement,but experienced different degree of footdrop and hypoesthesia of lower extremities； one poor improvement and experienced not only lower extremity dysfunction but also bladder and bowel dysfunction.According to Majeed scale in the final follow-up,clinical functional outcome was excellent in 12 cases,good in three,fair in one and poor in one,with excellent-good rate of 88％.Gibbons score improved from preoperative (3.29 ±0.47) points to postoperative (1.53±0.94) points (t=12.94,P＜0.01).Conclusion Posterior decompression plus lumbar pedicle screw fixation combined with sacral pedicle screw and/or iliac screw fixation is an effective method for treatment of unstable sacral fracture,for it can restore general stability of spine-pelvis,facilitate neurological function recovery and allow early weight-bearing.

An originate angiotensin Ⅱreceptor-neprilysin inhibitor sacubitril/valsartan with double effect and a new active mode can not only promote the protection of heart and neuroendocrine system , but also inhibit renin-angiotensin-aldosterone system .Sacubi-tril/valsartan is the first and only one conformed by clinical trials with better efficacy when compared with standard therapy drug enala -pril, and its safety is higher as well .Sacubitril-valsartan represents a promising new treatment option for heart failure patients with low-ered risk of cardiovascular death and hospitalization for heart failure .

Objective To investigate surgical treatment for tumor involved inferior vena cava at the upper segment of kidney.Methods The clinical data of 35 patients with tumor involved inferior vena cava at the upper segment of kidney who were admitted to Changhai Hospital affiliated to the Second Military Medical University from January 2007 to May 2015 were retrospectively analyzed.All the patients received preoperative imaging examinations to insure the site and range of inferior vena cava involvement at the upper segment of kidney.Renal cell carcinomas with inferior vena cava involvement were found in 19 cases,leiomyosarcomas of inferior vena cava in 5 cases,leiomyomatosis involving inferior vena cava in 3 cases,adrenocortical carcinoma involving inferior vena cava in 3 cases,liver cancer involving inferior vena cava in 2 cases,right adrenal pheochromocytomas in 2 cases,retroperitoneal fibrosarcoma involving inferior vena cava in 1 case.According to tumor involvement types,the different surgical approaches,planes and method of inferior vena cava exclusion,reconstruction method and prevention of tumor embolus detachment were selected.Patients were followed up by outpatient examination and telephone interview till May 2015.Results Among 19 patients with renal cell carcinomas with inferior vena cava involvement,10 patients were placed inferior vena cava filters through internal jugular vein before surgery,10 patients underwent total hepatic vascular exclusion and 9 patients underwent intrahepatic inferior vena cava exclusion.All the 19 patients received tumor resection and inferior vena cava embolectomy.Of the 5 patients with leiomyosar-comas of inferior vena cava,3 patients underwent total hepatic vascular exclusion and 2 patients underwent intrahepatic inferior vena cava exclusion.The diseased segments of 5 patients were resected,including 4 patients of artificial vascular graft and 1 patient complicated with resection of right kidney receiving simple ligation of inferior vena cava and left renal vein at proximal and distal tumors.Of the 3 patients with leiomyomatosis involving inferior vena cava,2 patients received total hepatic vascular exclusion and 1 was treated surgically under cardiopulmonary bypass.All the 3 patients underwent inferior vena cava embolectomy and hysterectomy.Three patients with adrenocortical carcinoma involving inferior vena cava and 2 patients with liver cancer involving inferior vena cava underwent total hepatic vascular exclusion.Among the 5 patients,4 had direct suture after tumor removal combined with partial inferior vena cava resection,and 1 had patch repair after partial inferior vena cava resection.Two patients with right adrenal pheochromocytomas were exposed proximal and distal lifting devices of inferior vena cava without clamp,and the tumors were peeled off completely.Intraoperative death happened in the patient with retroperitoneal fibrosarcoma involving inferior vena cava who was prepared to undergo intrahepatic inferior vena cava exclusion but encountered intraoperative pulmonary embolism due to tumor thrombus shedding.Thirty-four patients of 35 patients underwent operation successfully without serious perioperative complications and a patient died in the perioperative period.The mean operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were 2.8 hours (range,1.5-5.0 hours),2 000 mL (range,400-5 000 mL) and 9.2 days (range,6.0-16.0 days).Thirty-four patients were followed up for a median time of 12 months (range,1-60 months).During the follow-up period,a patient with leiomyosarcomas of inferior vena cava and 2 patients with adrenocortical carcinoma involving inferior vena cava died of tumor recurrence,a patient with liver cancer had tumor recurrence,other patients were tumor-free survival.Conclusions Inferior vena cava at the upper segment of kidney is not contraindication for tumor resection.The appropriate way to expose,clamp and reconstruct are selected to safely remove the tumor based on extension and method of tumor involving inferior vena cava.

Objective To investigate the clinical efficacy and safety of the uni-extrapedicular percutaneous kyphoplasty (PKP) versus the unipedicular PKP in the treatment of lower osteoporotic vertebral compression fractures (OVCF).Methods From January 2011 to January 2013,47 patients with lower OVCF were treated at our department.The uni-extrapedicular PKP was conducted for 25 of them (28 compressed vertebrae,group A) while the unipedicular PKP for the other 22 (24 compressed vertebrae,group B).The 2 groups were compatible,showing no significant differences in preoperative clinical data (P ＞ 0.05).The 2 groups were compared in terms of operation time,fluoroscopy frequency,volune of injected cement,cement leakage,and cobb angle,anterior vertebral height,visual analogue scale (VAS) score,Oswestry disability index (ODI),SF-36 score,and cement filling preoperatively,3 days and one year postoperatively.Results All the patients had an uneventful operation and were followed up for at least one year.Compared with group B,group A reported significantly shorter operation time,lower fluoroscopy frequency,less cement leakage,better cement filling,and a lower rate of fracture of adjacent vertebra (all P ＜ 0.05).Compared with preoperation,all the patients obtained significant improvements in cobb angle,anterior vertebral height,VAS score,ODI,and SF-36 score after operation (all P ＜ 0.05),but there were no significant differences between the 2 groups in terms of the above items postoperatively (P ＞ 0.05).Conclusion Both of the 2 methods are safe and effective treatments of OVCF,but the uni-extrapedicular PKP may be more advantageous because it leads to shorter operation time and lower fluoroscopy frequency.

Objective To evaluate the changes in the epidemiology and clinical characteristics of cervical carcinoma over the past 50 years, and to explore the equitable treatment corresponding to these changes. Methods The clinical and pathological data of 1557 patients with invasive cervical carcinoma from January 1955 to December 2004 were retrospectively analyzed. Results (1) The average age of cervical carcinoma onset gradually decreased over the past 50 years, from 56.27?8.45 in years 1955~1964 to 43.81?8.9 in years 1995~2004. At the same time, the radio of clinically early (stages Ⅰ-Ⅱ) and non-squamous cancer also steadily increased. (2) Young patients (≤35 year old) had higher ratios of non-squamous, poorly differentiated and late stage (Ⅲ-Ⅳ) cancers, with a higher rate of lymphatic metastasis compared with other ages. (3) Because of the changes in epidemiology and clinical characteristics of cervical carcinoma, it′s necessary to alter the traditional model of treatment and to explore equitable therapy corresponding to these changes. Conclusions The average age of cervical carcinoma onset gradually decreased and simultaneously the ratio of clinically early (stages Ⅰ-Ⅱ) and non-squamous cancer also steadily increased over the last 50 years. Patients aged 35 and younger of cervical carcinoma had some obvious clinical characteristics compared with that of older patients. Preservation of reproductive endocrine function ought to be deliberated on in cervical carcinoma treatment of women with fecundity. Neoadjuvant intraarterial chemotherapy (NAIC) is an useful method for cervical carcinoma at present