Objective To investigate the efficacy and optimal dose of adrenocorticotropic hormone(ACTH) in treatment of infantile spasms (IS).Methods Sixty patients with IS were randomly divided into group A (ACTH 20 IU/d,n =20),group B (ACTH 40 IU/d,n =20) and group C (Depakine syrup,n =20) in a prospective randomized study.Patients in group A and group B were given ACTH in the dose of 20 IU/d and 40 IU/d for 2 weeks,respectively.After 2 weeks of treatment,ACTH administration was replaced by oral prednisone if the seizure frequency decreased by 50.0％ or less.Patients showing incomplete control of epilepsy(seizure frequency reduction less than 50.0％) or failing to respond to treatment were continuously treated with the original amount of ACTH for another 2 weeks,then ACTH was replaced by oral prednisone.Patients in group C were treated with the combination regimen of oral clonazepam and Depakine syrup routinely.All participants were followed up by 0.5-3.0 years.The differences in clinical efficacy,changes in electroencephalogram(EEG) and adverse reactions in 3 groups were compared and analyzed.Results Mter 4 weeks of treatment,the total effective rates (TER) and EEG remission rate (ERR) in group A [TER:75.0％ (15/20 cases),ERR:40.0％ (8/20 cases)] and group B [TER:70.0％ (14/20 cases),ARE:45.0％ (9/20 cases)] were significantly higher than those in group C [TER:30.0％ (6/20 cases),ERR:10.0％ (2/20 cases)] (x2 =10.011,6.624,all P ＜ 0.05),respectively,while no significant difference was found between group A and group B as for seizure control,hypsarrhythmia EEG resolution,and cognitive function restoration (x2 =0.125,0.000,t =1.95,all P ＞ 0.05).During follow-up study,the TER and ERR in group A [TER:30.0％ (16/20 cases),ERR:35.3 ％ (6/17 cases)] and group B [TER:30.0％ (6/20 cases),ARE:37.5％ (6/16 cases)] were also significantly higher than those in group C [TER:5.0％ (1/20 cases),ARE:5.9％ (1/17 cases)] (x2 =4.329,6.455,all P ＜ 0.05),respectively.The incidence of adverse reactions in group A was lower than that in group B (x2 =3.956,P ＜ 0.05).Conclusions ACTH proves to be an effective drug for the treatment of IS.Administration of ACTH in the dose of 20 IU/d for 2 weeks seems to be an optimal treatment recipe with remarkable efficacy with fewer adverse effects and may be worthy of clinical trials in a larger cohort.

Adolescent ; Adult ; Catheterization, Central Venous ; instrumentation ; Device Removal ; Humans ; Male ; Vena Cava, Inferior ; Vena Cava, Superior

Objective To study arterial distribution of rectus abdominis musculocutaneous flap and to evaluate whether it can be divided into several units for reconstruction. Methods The arteries of the rectus abdominis musculocutaneous flap were studied on 60 sides of cadavers by dissection and angiography. Results The superior epigastric artery (SEA) and the inferior epigastric artery (IEA) continued in a longitudinal direction. Most of their branches took on a typical spiral configuration and communicated with each other within muscle above the level of umbilicus. Many perforating arteries penetrated through the anterior rectus sheath to get to the overlying skin, but the highest concentration of major perforators were in the paraumbilical area. The inferior epigastric artery was more significant than superior epigastric artery in supplying the skin of the musculocutaneous flap. Based on thefstudies of the vascular anatomy of muscles, we could classify arterial distribution into 3 types: type Ⅰ (SEA 26.5 %, IEA 34.6%) revealed a single main intramuscular artery: type Ⅱ (SEA 64.7 %, IEA 48.1%) had two major intramuscular branches; type Ⅲ (SEA 8.8%, IEA 17.3 %) revealed three intramuscular branches. Our anatomic studies showed that the superior and inferior epigastric artery bifurcated or divided into more than two main branches in the majority of cases (SEA 73.5%, IEA 65.4%). Conclusion The rectus abdominis musculocutaneous flap could often be divided into several regions for breast construction which is based on the distribution of each branch of the artery.

Objective To investigate the expressions of TRIM59,Twist and E-cadherin in hepatocellular carcinoma and their clinical significance. Methods The expressions of TRIM59,Twist and E-cadherin protein were tested by immunohistochemistry in 80 cases of hepatocellular carcinomas and the adjacent paracancerous tissues. Results The positive rate of TRIM59 in hepatocellular carcinoma was significantly higher than that in the adjacent paracancerous tissue(76.3%vs. 8.0%,P<0.05). Significant difference was also observed in the expres-sion rate of Twist between the hepatocellular carcinomas and the paracancerous tissue(66.3%vs. 6.0%,P<0.05). The positive rate of E-cadherin in hepatocellular carcinoma was significantly lower than that in the adjacent para-cancerous tissue(27.5%vs. 90.0%,P<0.05). The differences of the expression of TRIM59 in hepatocellular carci-noma of pathological grading,tumor differentiation,vascular invasion and clinical TNM stage were significant(P<0.05). The differences of the expression of Twist in hepatocellular carcinoma of pathological grading ,differentia-tion,vascular invasion and clinical TNM stage was also significant(P<0.05,respectively). The differences of the expression of E-cadherin in hepatocellular carcinoma of pathological grading,differentiation,vascular invasion and clinical TNM stage were also significant(P<0.05,respectively). Significantly positive correlation was also found between TRIM59 and Twist by using spearman correlation analysis(P<0.05). Negative correlations were observed between TRIM59 and E-cadherin(P < 0.05),and between Twist and E-cadherin(P < 0.05). Survival analysis showed that TRIM59 expression was an independent prognostic factor in hepatocellular carcinoma. Conclusion TRIM59,Twist and E-cadherin protein expression might be associated with the development,invasion,and metas-tasis of hepatocellular carcinoma. TRIM59 may become a new target gene for the treatment of human hepatocellular carcinoma.

Objective To evaluate the effects of oxycodone combined with incision infiltration with ropivacaine on postoperative outcomes in the patients undergoing laparoscopic cholecystectomy.Methods Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 33-64 yr,weighing 45-88 kg,scheduled for elective laparoscopic cholecystectomy under general anesthesia,were divided into 2 groups (n=40 each) using a random number table:patient-controlled intravenous analgesia group (group P) and oxycodone combined with incision infiltration group (group O).In group P,fentanyl 1-2 μg/kg was intravenously infused after cholecystectomy,and patient-controlled intravenous analgesia was performed with sufentanil at the end of surgery.In group O,oxycodone 0.05-0.10 mg/kg was intravenously injected after cholecystectomy,incision infiltration was performed with 0.5％ ropivacaine before suturing,and visual analog scale score was maintained ≤ 3.The emergence time,time to first flatus,time to liquid diet,first ambulation time,length of hospital stay after operation and adverse reactions were recorded.Results Compared with group P,the time to first flatus,time to liquid diet,first ambulation time and length of hospital stay after operation were significantly shortened,the incidence of urinary retention and nausea and vomiting was decreased (P＜0.05),and no significant change was found in the emergence time in group O (P＞0.05).Conclusion Combination of oxycodone and incision infiltration with ropivacaine can promote postoperative outcomes in the patients undergoing laparoscopic cholecystectomy.

Objective To study the effect of theory and practice integrated teaching in der-matology education and to explore the effective teaching means. Methods 53 five-year program stu-dents of Grade 2008 who major in clinical medicine were subjects. 26 students involved in the inves-tigation were taught with theory and practice integrated teaching. 27 students were taught with tradi-tional teaching method. In order to understand the teaching effect, we use questionnaire in experimental group and carry on comprehensive evaluation in both group at the end of the course . Descriptive statistics method was applied to describe the experimental group students' evaluation of the theory-practice integration teaching methods; The results of the two groups of students were applied t-test to perform statistical analysis and the difference was statistically significant (P<0.05). Results The stu-dents in the experimental group hold positive attitudes to theory and practice integrated teaching. 25 students (96.2%) in experimental group confirmed the necessity of it and considered that it could improve the communication skill. 24 students (92.3% ) confirmed it attractive and considered that it could improve the learning interest and capacity of clinical practice. 23 students (88.5% ) thought active learning and learning efficiency were promoted and theoretical knowledge was consolidated. 22 students (84.6%) considered that it could promote the comprehension of dermatology. Besides, the ex-perimental group students' medical ethics, theory and skills were significantly higher than those of the control group (P<0.05). Conclusion Theory and practice integrated teaching in dermatology edu-cation is effective. It can promote students' learning interest and initiative. It can improve the profes-sional quality of students and comprehensive quality of teachers.

Objective To evaluate the echocardiographic findings and clinical application in the rupture of sinus of Valsalva aneurysm(SVA).Methods Typical transthoracic echocardiographic appearance of 62 patients with SVA and accompanied abnormality were reviewed and compared with operative results.Results Fifty-eight (93.5%) cases SVA were preoperatively discovered by echocardiography, while 2 (3.2%) misdiagnosed as tetralogy of Fallot and tricuspid regurgitation and 2 (3.2%) missed diagnosis.Accompanying teratisms included frequently ventricular septal defect (VSD) (33 cases, 53.2 %) and aortic valve dysplasia(11 cases, 17.7%).The rupture site and the drainage chamber were essentially consisted with surgery,while the size of VSD measured by echocardiography was significantly smaller than that measured in operation.Conclusions Transthoracic echoeardiography is valuable in diagnosing of the site, drainage chamber and the accompanied abnormality of SVA.

Objective To discuss the significance of high frequency ultrasound for diagnosis of congenital anomoly of pediatric kidneys. Methods Totally 118 patients with congenital anomoly of pediatric kidneys were examined with high frequency ultrasound,the characteristics of the images were analysed.Results Congenital anomoly kidneys had great diversity of variety in number,size,position,axial direction,abnormal vein and renal pelvis. In the 118 cases,pelvi ureteric stenosis was in 72 cases,renal duplication in 23,renal hypoplasia in 10,kidney deficit in 7,rotatory anomaly in 1,fused kidney in 1,and double renal pelvis in 4. Conclusions High frequency ultrasound is beneficial for diagnosing and differential diagnosing congenital anomoly of pediatric kidneys.

Adult ; Heart Aneurysm ; congenital ; Heart Atria ; pathology ; Humans ; Male

Objective To discuss how to use the core elements of international classification of functioning,disability and health(ICF) as a guide in stroke operation treatment to develop targeted,effective therapy plan and rehabilitation goals,establish individualized treatment of rehabilitation,and to observe the effect of limb movement function in stroke patients. Methods Sixty cases patients with stroke and aged from 40 to 65 years old were selected. The body function and structure of all stroke patients were marked by comprehensive evaluation scores of The National Institutes of Health Stroke Scale ( NIHSS ) and Fugl?Meyer assessment. And then they were randomly divided into two groups,30 cases in each group. The observation group used the Chinese version of brief ICF Core Sets for evaluation, and set individualized treatment according to the results of the assessment;The control group, according to the conventional rehabilitation process, involved in training routine physical therapy. Again 8 weeks after treatment for patients with evaluation,the assessment results was compared with the results of the first assessment. Results Before treatment, the NIHSS, Fugl?Meyer assessment and Chinese version of brief ICF core elements scale scores for the observation group were 7. 95±2. 37,34. 5±4. 0 and 82. 15±17. 96,for the control group were 7. 58±2. 25,34. 8±4. 0 and 81. 55±18. 78. After treatment,the above three rating scale scores, for the observation group were improved to 4. 78 ± 1. 63, 56. 3 ± 4. 2, 60. 45 ±11. 04,for the control group were improved to 5. 13±1. 75,48. 1±3. 8,73. 56±16. 89. The two groups were significantly improved ( observation group:t=4. 94, 15. 51, 18. 59, P<0. 05;control group:t=3. 17, 14. 66, 12. 33,P<0. 05). After treatment,compared with the control group of three rating scale scores(5. 13±1. 75,48. 1
±3. 8 and 73. 56±16. 89),the observation group(4. 78±1. 63,56. 3±4. 2 and 60. 45±11. 04) improved more apparently(t=3. 15,14. 54,15. 45,P<0. 05) . Conclusion Guided by the idea of ICF and scale,with the demand of the patients as the center,to develop personalized physical therapy,can achieve more productive and more targeted rehabilitation goals.