Objective To compare the clinical curative effect of endoscopic retrograde cholangio-pancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) in treatment of malignant obstructive jaundice. Methods Clinical data of 97 patients with malignant obstructive jaundice were collected and analyzed retrospectively, includs 54 patients in ERCP group and 43 patients in PTCD group. The clinical curative effect, postoperative complications, comfort score and hospitalization time and costs were compared between the two groups. Results The symptoms improved compared with preoperative. The total remission rate of jaundice in ERCP group and PTCD group was 77.78％ vs 79.07％, and the remission rate of high obstructive jaundice was 55.00％, vs 89.29％, and the remission rate of low obstruction jaundice was 91.18％, vs 60.00％.There was significant difference between the two groups (P < 0.05); The incidence of postoperative complications in ERCP group and PTCD group was 37.04％ vs 16.28％. There was significant difference between the two groups (P < 0.05); The comfort scale of ERCP group and PTCD group was (15.13 ± 3.89) points vs (16.60 ± 3.15) points. There was significant difference between the two groups (P < 0.05); The hospitalization time of ERCP group and PTCD group were (8.74 ± 4.94) days vs (11.12 ± 4.82) days, and the hospitalization costs were (22.70 ± 6.30) thousand yuan vs (21.90 ± 3.40) thousand yuan. Conclusion Satisfactory clinical curative effect for patients with malignant obstructive jaundice can be derived from both ERCP and PTCD. The treatment of ERCP has more advantages than PTCD in patients with low obstruction, while PTCD is better than ERCP in patients with high obstruction. But ERCP group is better than PTCD in comfort score and shorter in hospitalization time. There is no obvious difference on hospitalization costs.

Objective To evaluate the effect of ropivacaine combined with low-dose naloxone or sufentanilropivacaine mixture on brachial plexus block carried under the guidance of ultrasound.Methods A total of 100 patients of our hospital undergoing upper limb surgery was randomly divided into four groups with 25 patients in each group.Four groups are patients receiving 20 mL of 0.375％ mesylate ropivacaine (Group D),20 mL of 0.375％ mesylate ropivacaine + 10 μg sufentanil (Group S),20 mL of 0.375％ mesylate ropivacaine + 100 ng naloxone (Group N) and 20 mL of 0.375％ mesylate ropivacaine + 10 μg sufentanil +100 ng naloxone (Group N+S).All patients underwent interscalene brachial plexus block under ultrasound guidance.The sensory block,motor block and other adverse reactions were observed and recorded at 5min,6,12,18,24 h.Results The sensory and motor block time of group D was (435.5 ± 77.9) min and (350.2 ± 69.8) min,group S (831.7 ± 52.0)min and (675.8 ± 48.1)min,group N (933.0 ± 117.1) min and (499.0 ± 40.5) min,group N+S (919.3 ± 59.0) min and (534.8 ± 56.6)min.The sensory block time of group N and group N + S were significantly longer than that of group D and S (P ＜0.05).The sensory and motor block time of group D were obviously shorter than that of other groups (P ＜ 0.05).There were no significant difference in the onset time of sensory and motor block in all groups.Conclusion Low dose of naloxone combined with ropivacaine or sufentanil-ropivacaine mixture can increase the duration of sensory block on brachial plexus.

Adult ; Diskectomy ; methods ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods

With the kernel of efficacy, "Xiaohe Silian" was a pattern and method for new drug discovery which was constituted with "metabolism-efficacy, toxicity-efficacy, quality-efficacy and structure-efficacy". Its connotation was in keeping with traditional Chinese medicine (TCM) clinical pharmacy. This paper systematically summarized the research method of new drug discovery practice process for TCM. To avoid western drug like in TCM new drug discovery, we carried out combination analysis with TCM clinical pharmacy. The correlation analysis between basic elements of "Xiaohe Silian(n) and TCM clinical pharmacy was studied to guarantee this method could integrate closely with TCM clinic from all angles. Hence, this method aimed to provide a new method for TCM new drug discovery on the basis of TCM clinical pharmacy with insisting on holistic view of multicomponent study, kinetic view of metabolic process when the curative effect occurred and molecular material view of quality control and structure-activity exposition.
Drug Discovery ; methods ; Drug Therapy ; Drugs, Chinese Herbal ; analysis ; pharmacology ; Humans ; Medicine, Chinese Traditional

OBJECTIVETo compare the effect of autograft, cage and autograft plus internal fixation with plate on maintenance of disc height and recovery of spinal cord function.

METHODSFrom March 1998 to June 2004, 117 cervical spondylotic patients who received anterior fusion surgery were reviewed. There were 65 males and 52 females with an average age of 57 years (range from 31 to 72 years). One level was involved in 91 patients, and two levels in 26. Fusion methods included autogenous tri-cortical iliac bone grafting alone in 31 patients, cage with autograft bone in 38 and autogenous tri-cortical iliac bone grafting combined with self-locking plate in 49. The measured fusion length was determined as the distance from the midpoint between the anterior and posterior aspects of the superior endplate of the top level of the fusion to the midpoint of the inferior endplate of the bottom level of the bottom level of the fusion. JOA rating criteria was used for cord function evaluation. One-way variation analysis was used to compare the disc height loss and cord function among the 3 groups.

RESULTSAll patients were followed-up for an average period of 23 months (range, 13 to 59 months). At final follow- up, disc height loss averaged 1.94 mm in autogenous tri-cortical iliac bone grafting group, greater than that in the other two groups (1.48 mm in cage group and 1.25 mm in instrumented group) with statistical significance. Recovery of spinal cord function was satisfactory in all groups at one year postoperatively with no statistical difference. Three implants failure occurred in self-locking plate group and was salvaged with uneventful recovery.

CONCLUSIONSIn anterior cervical fusion surgery, maintenance of disc height could be achieved by proper application of cage or internal fixation with plate.

Adult ; Aged ; Bone Plates ; Cervical Vertebrae ; pathology ; surgery ; Decompression, Surgical ; instrumentation ; methods ; Female ; Humans ; Ilium ; transplantation ; Male ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; instrumentation ; methods ; Spinal Osteophytosis ; surgery ; Transplantation, Autologous ; Treatment Outcome

Objective To analyze the clinical features of isolated hematuria Henoch-Schonlein purpura nephritis (HSPN). Methods The clinical data of children with isolated hematuria HSPN diagnosed in the First Affiliated Hospital of Henan University of Chinese Medicine from November 2003 to December 2014 was analyzed retrospectively. Results One hundred and thirty-five isolated hematuria HSPN patients were rolled in the study. Eighty cases were male and fifty-five cases were female. Male to female was 1. 45:1,average age was(9. 24 ± 5. 32)years old. Thirty one cases had pure skin purpura, thirty three cases had purpura accompany with abdominal pain,twenty eight cases had purpura accompany with arthralgia,forty three purpura accompany with abdominal pain and arthralgia. The pathogenesis was (8. 62 ± 7. 28)months. Seven cases were given nephridial tissue biopsy. In the 135 cases,there were 31 cases accepted general therapy,and 104 cases accepted the ther-apy of immunodepressant. In the patients with general therapy,there were 19 cases with recovery,8 cases with isolated hematu-ria,3 cases with mild proteinuria,1 case with moderate proteinuria. In the patients with therapy of immunodepressant,there were 72 cases with recovery,23 cases with isolated hematuria,7 cases with mild proteinuria,one case with moderate proteinuria,one case severe proteinuria. There was no significant difference in the prognosis between the general therapy patients and immu-nodepressant therapy patients(z = 0. 65,P = 0. 516). Conclusion The prognosis of the HSPN in children accompany with iso-lated haematuria is favourable,but a few patients may progress to moderate and severe proteinuria.

The efficiency of the exogenous DNA transfecting mouse sperm was studied by the DIG end labeled and immunohistochemistry technology. The results suggested that: the efficiency of transfecting positive rate of individual mouse sperm was distinct difference (P < 0.01), and the average rate was 13%. The acrosomal reaction was evaluated using the technology of Coomassie brilliant blue stained, and the appropriate in vitro fertilization (IVF) medium TYH was elected. Mouse sperms were transferred with GFP gene in vitro, and the mature oocytes were fertilized using IVF, and then the zygotes were cultured in vitro. The embryos were observed using the fluorescence microscopy, and the transgenic rate was 4.7%. The results suggested that sperm mediated gene transfer (SMGT) was an effective and feasible method.
Animals ; Embryo, Mammalian ; cytology ; metabolism ; Feasibility Studies ; Female ; Fertilization in Vitro ; Gene Expression ; Gene Transfer Techniques ; Green Fluorescent Proteins ; genetics ; metabolism ; Male ; Mice ; Mice, Inbred ICR ; Mice, Transgenic ; Microscopy, Fluorescence ; Oocytes ; cytology ; metabolism ; Spermatozoa ; cytology ; metabolism ; Zygote ; cytology ; metabolism

OBJECTIVETo investigate the potential role of Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway in regulation of gene expression of high mobility group box-1 protein (HMGB1) in various tissues in rats with sepsis.

METHODSA sepsis model reproduced by cecal ligation and puncture (CLP), and 128 male Wistar rats were randomly divided into normal control group (n = 10), sham operation group (n = 10), CLP group (n = 60), AG490 treatment group (n = 24), and rapamycin (RPM) treatment group (n = 24). At serial time points animals in each group were sacrificed after CLP, then tissue samples were harvested to determine HMGB1 mRNA expression and STAT1/3 DNA binding activity.

RESULTSSTAT1 activities increased rapidly in the liver, lungs and small intestine after CLP, peaking at 6 - 12 h, while it increased slowly, and still kept at mild level from 2 to 48 h in the kidneys. Compared with STAT1, lower STAT3 activities were detected only in the liver and lungs, with negative detection in the small intestine and kidneys. HMGB1 mRNA levels significantly increased in liver, lungs and small intestine at various time points after CLP respectively (P < 0.05 or P < 0.01), while they didn't change in the kidneys. Treatment with AG490 could markedly inhibit HMGB1 mRNA expression in the liver and small intestine at 24 and 48 h (P < 0.05 or P < 0.01), and in lungs at 2 h following CLP (P < 0.01). Similarly, treatment with RPM significantly decreased HMGB1 mRNA expression in the lungs at 2, 6, 24 and 48 h, in the liver at 6 and 24 h, and in the small intestine at 24 and 48 h (P < 0.05 or P < 0.01). In addition, STAT1 and STAT3 activities in the liver and lungs were significantly correlated with corresponding tissue HMGB1 mRNA expression.

CONCLUSIONSPeritoneal infection could extensively activate STAT1 and limitedly activate STAT3 in vital organs. Activation of JAK/STAT pathway might be involved in up-regulating the gene expression of HMGB1 and systemic inflammation secondary to severe septic challenge.

Animals ; Disease Models, Animal ; Gene Expression ; physiology ; HMGB1 Protein ; genetics ; Janus Kinases ; metabolism ; Male ; RNA, Messenger ; genetics ; Random Allocation ; Rats ; Rats, Wistar ; STAT Transcription Factors ; metabolism ; Sepsis ; genetics ; physiopathology ; Signal Transduction

Objective To explore the method of WeChat medication education for patients used by pharmacists,and to investigate the effect of WeChat medication education at Peking university third hospital.Methods Totally 30 patients who used warfarin at Peking university third hospital were enrolled.A series of subscriptions concerning warfarin medication education were sent to patients and/or their caregivers by WeChat regularly.The medication knowledge score after/before the intervention were assessed.Results The score of patients' warfarin medication knowledge before intervention was (14.20 ± 1.97) points,and after that the score was (16.63 ± 1.74) points,showing an improvenent with significance (P ＜ 0.001).Questions about adverse events of warfarin were most likely to be answered by mistake and the score of relevant questions was only (0.97 ± 0.80) points and (1.07 ± 0.81) points,respectively (P ＞ 0.05) before and after intervention.Conclusion It is of great significance for pharmacists to provide warfarin medication education.It is proved effective to improve patients' recognition of warfarin medication by means of WeChat subscriptions.

OBJECTIVETo identify the factors that affect the safety and efficacy of peroral endoscopic myotomy (POEM) for treatment of achalasia.

METHODSData of consecutive patients undergoing POEM for confirmed achalasia between December, 2010 and December, 2015 were collected, including the procedure time, approach of tunnel entry incision, approach of myotomy, complications and follow-up data.

RESULTSAmong the total of 439 patients enrolled, the overall complication rate was 28.7% (126/439). Treatment success (Eckardt score≤3) was achieved in 94.5% of 364 patients followed up for a median of 6 months (1-48 months), and the mean score was reduced significantly from 6.7∓1.5 before treatment to 1.2∓1.1 after the treatment (P<0.05). Logistic regression revealed that the year when POEM was performed and the approach of entry incision were two significant factors contributing to complications: with the year 2015 as the reference, the odds ratio (OR) was 9.454 (95% CI: 2.499-35.76) for the years before 2011, 2.177 (95% CI: 0.794-5.974) for 2012, 3.975 (95% CI: 1.904-8.298) for 2013, and 1.079 (95% CI: 0.601-1.940) for 2014; with the longitudinal entry incision as the reference, the OR was 0.369 (95% CI: 0.165-0.824) for inverted T entry incision and 0.456 (95% CI: 0.242-0.859) for transverse entry incision. The approach of myotomy was the significantly associated with symptomatic relapse: with full-thickness myotomy combined with indwelling an anti-reflux belt as the reference, the OR was 0.363 (95% CI: 0.059-2.250) for gradual full-thickness myotomy, 2.137 (95% CI: 0.440-10.378) for circular muscle myotomy, and 4.385 (95% CI: 0.820-23.438) for circular muscle myotomy in combination with balloon shaping; the recurrence rate was 0 with a full-thickness myotomy.

CONCLUSIONThe complication rates of POEM appears to decrease over time, and an inverted T entry incision is the best choice for controlling the complications. Gradual full-thickness myotomy is an excellent approach for treatment of achalasia in terms of the relapse rate, procedure time and the incidence of reflux esophagitis.

Endoscopy ; Esophageal Achalasia ; surgery ; Esophagitis, Peptic ; surgery ; Gastroesophageal Reflux ; Humans ; Muscles ; surgery ; Recurrence ; Treatment Outcome