Objective To investigate the cause of refractory hiccups. Method 34 patients with refractory hiccups admitted to our hospital from January 1996 to December 2003 were examined with gastroscopy. The correlation of hiccups with reflux esophagitis and the efficacy of omeprazole treatment were studied. Results 10 patients were proven endoscopically to have esophagitis and duodenal ulcer, and the other 24 were suffering from esophagitis. According to Tokyo classification, 14 cases were having grade III esophagitis, and 20 were grade IV. All patients received omeprazole 20mg twice daily and cisapride 10mg thrice daily, and hiccups disappeared after 3 days. Conclusion Refractory hiccups may be the initial or primary symptom in moderate-severe esophagitis in aged people. Proton pump inhibitor therapy is effective in stopping refractory hiccup.

Objective To study the CT manifestations of metastatic lymph node of thyroid carcinoma. Methods CT appearances of metastatic lymph node of thyroid carcinoma proved by surgery and pathology in 108 patients were reviewed. Results Of these 108 cases, metastatic lymph nodes were located at superoir and middle internal jugular chain(n=76), inferior internal jugular chain and super clavicular region(n=86), tracheoesophageal groove(n=52), and superior mediastinum(n=17). Of 84 thyroid papillary carcinoma patients, the attenuation of metastatic lymph nodes were similar to that of normal thyroid gland(n=16), with cystic formations (n=24), intracystic high attenuation papillary-like nodules (n=18), and fine granular calcifications (n=11). Of 24 follicular carcinoma, medullary carcinoma, and clear cell carcinoma patients, 17 cases had significant homogeneous or heterogeneous enhanced nodes, and the attenuation was the same as primary or recurrent thyroid tumors. Conclusion For thyroid carcinoma, the most common locations of metastatic lymph nodes were internal jugular chain, tracheoesophageal groove, and superior mediastinum regions. Marked enhancement similar to normal thyroid gland, cystic formations with intracystic high attenuation papillary-like nodules, and fine discrete granular calcifications were the characteristic manifestations of metastatic lymph node of papillary carcinoma. Marked homogeneous or heterogeneous enhancement after contrast administration and the same attenuation as the primary or recurrent thyroid tumor were found in follicular carcinoma, medullary carcinoma, and clear cell carcinoma metastases.

The biologically active constituents in Gynostemma pentaphyllum are dammarane-type glycosides,called gypenosides.They are believed to be the highest contents of this herb,easy to obtain,and mainly active in anti-tumor,controlling the blood glucose,lipid-lowering,cardiovascular protection,etc.The saponins may change into sub-glucoside after hydrolysis,for the intemal acetal glucoside structure is vulnerable to acid,alkali,and enzyme degradation.Through searching the literatures in recent years,this paper summarized the chemical constituents in the hydrolyzed products of gypenosides,for providing references to discover novel and more active lead compounds.

Objective To quantitatively evaluate left ventricular layer-specific strain using speckle tracking imaging,and their relationship with age and gender in nornal subj ects.Methods GE Vivid E9 equipment with EchoPAC BT1 2 workstation were used.One hundred and nineteen healthy subj ects were enrolled in this study.Results Left ventricular global longitudinal and circumferential strain was highest in the endocardium and lowest in the epicardium.Longitudinal and circumferential 3-layer strain was highest in the apex and lowest in the base.Age and gender had little influence on the left ventricular layer-specific strain.Conclusions Speckle tracking imaging can quantitatively assess left ventricular layer-specific strain, providing another useful modality for evaluating cardiac function.

Objective To develop a tool capable of early and exactly predicting various outcomes in comatose survivors who restore spontaneous circulation after cardiopulmonary resuscitation (CPR) and validate its performance.Methods Variables that were both readily available and predictive of outcomes were identified by systematically reviewing published literature on resuscitation.A value was assigned to these variables.We used these variables in combination with APACHE Ⅱ/score to devise a multifactorial prediction score system,which we called PRCSs Prognostication Score (PRCSs-PS).Outcomes in 115 hospitalized comatose survivors after CPR were retrospectively reviewed using PRCSs-PS.Score of patients with different outcomes was compared.The area under the receiveroperating characteristic (ROC) curve was determined to evaluate performance of this tool to identify patients with a poor outcome (CPC4 and 5) and other outcomes (CPC1,2,and 3).Results There were differences of PRCSs-PS score among multiple groups with five different outcomes (CPC1-5)(F=65.91,P=0.000).Pairwise groups with different CPC were compared:no significant difference was noted between CPC 1 and CPC2 (12.41±6.49 vs 17.38±6.91,P=0.092),but difference between other pairwise CPC groups was statistically significant (CPC2 vs CPC3:17.38±6.91 vs 24.50±5.80,P=0.041,CPC3 vs CPC4:24.50±5.80 vs 32.29±5.24,P=0.006).The performance of PRCSs-PS to discriminate patients with a poor outcome from patients with other outcomes went as follows:it had 100% sensitivity,78.6% specificity,and 178.6 diagnostic index at the score cut-off22.5; it had 77.8% sensitivity,100% specificity and 176.4 diagnostic index at the score cut-off32.5.Score 23 and 33 were two key cut-offpoints.The area under the ROC curve was 0.968,showing excellent discrimination.Conclusions The final outcomes in post-resuscitation comatose survivors can be accurately predicted using PRCSs-PS Score.

Objective To observe the interfering effect of different doses of penehyclidine hydrochloride (PHC) on the mRNA expressions of nuclear factor kappa B (NF-κB) and inducible nitric oxide synthase (iNOS) in the lung tissue of rats with traumatic shock so as to investigate the protective role of PHC in secondary long injury following traumatic shock and the underlying mechanism.Methods The traumatic shock model was established.A total of 104 Wistar rats were randomly divided into four groups:control group,shock group,low dose PHC group ( P1 group) and high dose PHC group ( P2 group).At the beginning of resuscitation,the rats in P1 and P2 groups were given transjugular intravenous injection of 2 ml/kg isotonic saline containing 0.15 mg/kg and 0- 45 mg/kg PHC respectively,while the rats in shock and control groups were injected only isometric isotonic saline.The rats in the four groups were killed at 2 h,6 h,12 h and 24 h after resuscitation respectively to detect the mRNA expressions of NF-κB and iNOS by using RT-PCR and determine the lung wet/dry weight (W/D) ratio,lung permeability index (LPI) and lung injury score (LIS).Results The mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS at all the time intervals in the shock,P1 and P2 groups were all significantly increased as compared with those in the control group (P＜0.05).Howerver,the P2 group showed significant reduction in aspects of the mRNA expressions of NF- κB and iNOS,lung W/D ratio,LPI and LIS at all time points and P1 group also had significant decrease regarding the mRNA expressions of NF-κB and iNOS,lung W/D ratio at2 h,6 h,and LPI and LIS at 2 h,6 h,12 h,as compared with the shock group.Meanwhile,P2 group showed evident decrease at 6 h concerning the mRNA expressions of NF-κB and iNOS,lung W/D ratio,LPI and LIS as compared with P1 group (P ＜ 0.05 ).Conclusions PHC,especially at a large dosage,can significantly mitigate the long injury secondary to traumatic shock,and the mechanism may be associated with the inhibition of mRNA expressions of NF-κB and iNOS.

ObjectiveTo investigate comprehensive treatment and obstruction in adherence of the patients newly diagnosed with breast cancer,and to provide the theoretical basis for improving the comprehensive treatment adherence.Methods A total of 22 patients newly diagnosed with breast cancer received semi-structured interview by phenomenological research approach of qualitative research. Colaizzi′s data analysis method was performed to analyze and conclude the theme.Results Eight themes of the application were obtained from the experience of 22 patients:economic difficulties,weak family support,serious treatment side effects,tortile religious faith,incorrect internet information,indifference in combined treatment,complex formalities and complications. Conclusions The affecting factors,such as economic difficulties,are the most frequently endorsed barrier to combined treatment compliance. The management of affecting factors is critically significant to increase patients′ compliance to comprehensive treatment. Medical staff should offer individual economic and medical information as well as emotion supports,and encourage breast cancer patients to actively complete the comprehensive treatment.

ObjectiveTo understand the infection of AIDS， syphilis， and gonorrhea in men who have sex with men （MSM）， and the factors influencing the acceptance of gonorrhea testing in Dehong Dai Jingpo Autonomous Prefecture （Dehong Prefecture）， Yunnan Province. MethodsAcross-sectional survey was conducted to describe and analyze the acceptance of AIDS， syphilis， and gonorrhea testing among MSM tracked in Dehong Prefecture in 2018. ResultsA total of 385 MSM were included in the analysis， with a 100.0% HIV and syphilis testing rate. The HIV antibody positivity rate was 10.6% （41/385） and the positivity rate of syphilis antibody was 14.8%（57/385）. Only 30.4% of the subjects were willing to test for gonorrhea， and 13.7%（16/117）of them were test positive. Further multifactorial analysis revealed that local MSM and syphilis co-infected individuals were more likely to be tested for gonorrhea （aOR=2.48， 95%CI=1.33-4.65， P=0.004； aOR=2.59， 95%CI=1.43-4.71， P=0.002）. ConclusionThe positive rates of AIDS， syphilis and gonorrhea in MSM population in Dehong Prefecture are relatively high. Integrated interventions of STD/AIDS and gonorrhoea detection should be strengthened.

Objective: To study the prevalence and correlates of diabetes among HIV/AIDS who were on antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefectures (Dehong), Yunnan province. Methods: The database of HIV/AIDS receiving ART in Dehong was downloaded by using the basic information system of AIDS prevention and control in China. In this cross-sectional study, HIV/AIDS patients who were currently on ART and aged 18 years or above, were consecutively recruited, between July 2017 and June 2018, in Dehong. All the subjects underwent hemoglobin A1c (HbA1c) testing. Patient with diabetes was defined as meeting any of these indicators (HbA1c ≥6.5%, baseline FPG ≥7.0 mmol/L, FPG ≥7.0 mmol/L in the most recent visit). Both univariate and multivariate logistic regression analysis were carried on to evaluate the correlates of diabetes among the HIV/AIDS patients. Results: In total of 4 376 HIV/AIDS patients were included for analysis, with the average age as (43.7±10.1) years, proportion of males as 53.8% (2 356/4 376) and the HCV positive rate as 24.1% (1 055/4 376). The mean years was (8.9±3.8) years after the HIV diagnosis was made, and the mean duration on treatment was (6.8±2.9) years. The prevalence of diabetes was 11.4% (500/4 376). Through multivariate logistic regression analysis, data showed that the risk factors of diabetes of HIV/AIDS on ART were: aged 40 years or above, being male, HCV positive, baseline body mass index ≥24.0 kg/m², elevated TG ≥1.70 mmol/L in the most recent visit and baseline antiretroviral regimens under Efavirenz (EFV). Conclusions Prevalence rate of diabetes appeared higher in HIV/AIDS patients who were on ART in Dehong. Prevention and control measures should be targeted on HIV/AIDS patients who were with risk factors of diabetes as being elderly, male, HCV positive, overweight and higher TG. Further esearch is needed to evaluate the association between the use of EFV and diabetes.

OBJECTIVE: To analyze the hematological characteristics of HbE homozygotes. METHODS: Complete blood cells count and hemoglobin electrophoresis were used for phenotypic analysis of 78 cases with HbE homozygotes from Yunnan province, China. The PCR-fluorescence hybridization was used to detect the common gene mutation of thalassemia. The hematological indexes, including MCV, MCH, Hb, HbA2, HbF and HbE were statistically analyzed between groups with different sex, ages and compound α thalassemia status. RESULTS: In HbE homozygotes (HbEE), 89.5% (17/19) children presented mild to moderate microcytic hypochromic anemia, and 10.5% of them presented moderate anemia. 39.6% (19/48) of women with HbEE developed mild anemia ,while 11 cases of male with HbE homozygotes were asymptomatic. The levels of MCV and MCH in HbE homozygotes increased by co-inheritance of α thalassemia mutation. CONCLUSION The clinical phenotype of HbE homozygote shows highly heterogeneous, which is relates with age, sex and co-inheriting α-globin genotypes. In Hb EE women and children are more likely to develop mild to moderate anemia. The microcytic hypochromic anemia degree is relieved when HbEE combined with α- thalassemia.
Child ; China ; Female ; Genotype ; Hemoglobin E ; genetics ; Homozygote ; Humans ; Male ; Phenotype ; alpha-Thalassemia