Abdominal Pain ; diagnosis ; etiology ; therapy ; Acupuncture Therapy ; Adult ; Back Pain ; diagnosis ; therapy ; Diagnostic Errors ; Female ; Humans ; Male ; Middle Aged

ObjectiveTo compare the therapeutic effect of mininal]y invasive removal of intracranial hematoma and conservative treatment in curing hypertension cerebral hemorrhage of elderly patients.Methods60 patients with hypertension cerebral hemorrhage were divided into two groups.Group A were adopted minimally invasive removal of intracranial hematoma(YL-1 type puncture needle was used into the hematoma edge,and sucked slowly the hematoma), and group B were adopted medical treatment(antihypertensive drugs, dehydration, free radicals and nutrition conservative treatment) ,then clinical therapeutic effect and activity of daily living were observed.ResultsThe hematoma evacuation time in group A (4.5 ± 1.2) d is shorter than in group B (17.0 ± 1.9) d (t = 6.04 ,P ＜ 0.05) ; The rate of neurological function recovery in group A (66.7％) is higher than in group B(93.3％) (x2 = 5.46,P ＜0.05) ; The activity of daily living in group A (80.0％) was better than group B (50.0％) (x2 = 5.93, P ＜ 0.05).The complication rate in group A (30.0％) is lower than in group B (66.7％) (x2 = 8.08, P ＜ 0.05).ConclusionThe therapeutic effect of minimally invasive removal of intracranial hematoma in curing hypertension cerebral hemorrhage was better than medical treatment.

Objective To research the early effects and side-effects of the local advanced nasopharyngeal carcinoma patients using intensity-modulated radiotherapy(IMRT)combined with concurrent chemotherapy.Methods From January 2005 to January 2007,60 patients with nasopharyngeal carcinoma of stage m-IV b were received IMRT combined with concurrent chemotherapy in our center.Sixty patients were divided into paclitaxel concurrent group(32 patients)and cisplatin concurrent group(28 patients).The prescribing doses of the primary tumor were 68-72 Gy for each group.The patients of paclitaxel concurrent group patients of the cisplatin concurrent group got earlier radiodennatitis and radiation-induced mucositis but also got significantly higher rate of radiodermatitis,radiation-induced mucositis,radiation-induced leucopenia and gastrointestinal toxicity,as well as the loss of weight.No significant difference was found on liver and renal funcfons between two groups.Four patients(12.5%)of the paclitaxel concurrent group were broken-off,which was much better than the cisplatin concurrent group.There was no significant difference on the specific length of break-off time,the 2-year overall survival rate and the 2-year diseaee-free survival rate between two groups.Conclusions IMRT combined with concurrent chemotherapy of paclitaxel liposome for local advanced nasopharyngeal carcinoma results in less side-effects and better tolerance than IMRT combined with concurrent cisplatin chemotherapy.

Objective To investigate the efficacy of a modified duodenum-preserving pancreatic head resection (DPPHR) for the treatment of chronic pancreatitis.Methods The clinical data of 109 patients with chronic pancreatitis who received modified DPPHR at the Union Hospital of Huazhong University of Science and Technology from January 2004 to June 2013 were retrospectively analyzed.Of the 109 patients,66 were with mass in the head of the pancreas,29 were with calcification of the head of the pancreas,14 were with atrophy of the head of the pancreas and stones in the main pancreatic duct.The level of glucose of 56 patients were normal,34 patients had glucose tolerance abnormalities and 19 were complicated with diabetes mellitus.Modified DPPHR was carried out after confirming the diagnosis of chronic pancreatitis and excluding the malignancies by frozen pathological examination.The head of the pancreas was completely resected.The posterior pancreaticoduodenal aortic arch running parallel to the duodenum was preserved to guarantee the blood supply to the remaining duodenum.A thin sheet of the pancreatic tissue behind the intrapancreatic common bile duct and between the common bile duct and the duodenum was preserved to guarantee the blood supply to the common bile duct.The gastrointestinal tract was reconstructed with an anastomosis of the distal pancreas and the jejunum and an end-to-en anastomosis of the proximal jejunum and the distal jejunum.Patients were followed up via out-patient examination to learn the frequency of abdominal pain,analgesics usage and the endocrine function.The pain scale,life quality and endocrine function were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30),Gastrointestinal Quality of Life Index (GLQI) questionnaire,and oral glucose tolerance test (OGTT),respectively.Patients were followed up till January 2014.The measurement data and the count data were analyzed using the t test and the chi-square test,respectively.Results No patients died during the operation.The operation time,volume of blood loss and blood transfusion were (3.5 ± 0.7) hours,(360 ± 125) mL and (260 ±220) mL,respectively.After the operation,5 patients were complicated with pancreatic leakage,5 with bile leakage,2 with duodenal fistula and 1 with peritoneal bleeding,and all the patients were cured after conservative treatment.Four patients were complicated with abdominal abscess,1 patient of whom was treated by conservative treatment,and the remaining 3 patients were cured by drainage guided by B sonography.The duration of hospital stay was 13.8 days (range,10.0-32.0 days).The median time of follow-up was 18.0 months (range,3.0-24.0 months).A total of 102 patients were followed up for more than 9 months.At postoperative month 9,the ratio of patients with abdominal pain was decreased from 78.90％ (86/109) to 18.63％ (19/102),and the ratio of patients administered analgesics was decreased from 76.47％ (78/102) to 12.75％ (13/102),with significant difference between the indexes before and after operation (x2=76.57,74.31,P ＜ 0.05).The score of the EORTC QLQ-C30 was decreased from 58 ±36 before operation to 15 ±4 after operation,with significant difference (t =11.39,P ＜ 0.05).The score of GLQI was increased from 69 ± 8 before operation to 87 ± 15 after operation,with significant difference (t =20.05,P ＜ 0.05).The patient with diabetes mellitus was cured,and no newly onset of diabetes was found.Two patients received reoperation because of recurrence of stones in the distal pancreatic duct and pancreatogenic portal hypertension.Conclusion Modified DPPHR is effective for the treatment of chronic pancreatitis with low incidence of postoperative complications.

BACKGROUND:Though the effects of conservative or traditional open reduction and internal fixation in the treatment of thoracolumbar fractures are reliable and satisfactory for most cases, two methods also have shortages. Minimal-invasive percutaneous pedicle screw system provides a new available method. OBJECTIVE:To investigate the clinical effect of Sextant percutaneous pedicle screw system in the treatment of thoracolumbar fractures. METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or traditional open internal fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics of Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. RESULTS AND CONCLUSION:Except two patients in traditional open internal fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. Operative time, intraoperative blood loss, postoperative drainage amount and hospital day were better in percutaneous pedicle screw fixation group than in the traditional open internal fixation group (P<0.05). Compared with preoperation, the sagittal Cobb angle, visual analogue scale and Oswestry disability index after operation were significantly lower (P<0.05), while anterior vertebral body height ratio was significantly higher in each group (P<0.05). No significant difference was found in terms of correction loss and Oswestry disability index between two groups at 8 months after operation (P>0.05). The results show that percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, obeying indication strictly is very important for clinical application.

BACKGROUND:The effects of both conservative and traditional open reduction and internal fixation are dissatisfactory in the treatment of thoracolumbar fractures, however, minimal-invasive percutaneous pedicle screw-rod systems provide a new available method.
OBJECTIVE:To investigate the clinical effect of percutaneous pedicle screw fixation using Sextant minimal-invasive system in the treatment of thoracolumbar fractures.
METHODS:A total of 55 patients, who had undergone percutaneous pedicle screw fixation using Sextant system (25 patients) or open pedicle screw fixation (30 patients) for single-level vertebral body compression fractures in Department of Orthopedics, Renmin Hospital of Wuhan University from February 2011 to January 2013, were enrol ed in this study. They showed no neurological signs and symptoms. The operative time, intraoperablood loss, postoperative drainage amount, length of hospital stay, pre-and post-operative Cobb angle and anterior vertebral body height ratio were recorded and compared between two groups.
RESULTS AND CONCLUSION:Except two patients in open pedicle screw fixation group were lost after discharge, al other patients were fol owed up for 8-14 months. There were significant differences in operative time, intraoperative blood loss, postoperative drainage amount and length of hospital stay between two groups (P=0.000 0). The post-operative Cobb angle was significantly lower while anterior vertebral body height ratio was significantly higher at one week than those before fixation in two groups (P=0.000 0). No significant difference was found in correction loss between two groups at 8 months after operation. Experimental findings indicate that, percutaneous pedicle screw fixation using Sextant system has a satisfactory outcome in the treatment of thoracolumbar fractures. However, understanding the correct indications is very important for clinical application.

Objective To explore effects of heat stress response on neutrophil apoptosis and respiratory burst function. MethodsNeutrophils from each of 18 healthy volunteers were divided into 3 parts,and one part was served as control group,and the other two parts were induced by heat shock or cadmium chloride for heat stress response and named as heat shock group and cadmium chloride group.The neutrophils were incubated in culture medium.At 0,2,3,4,and 6 h following heat stress induction,the heat shock protein(HSP70) expression and the respiratory burst were detected in the neutrophils respectively by using PCR technique and flow cytometer.Level of apoptosis was observed by immuno-fluorescence and flow cytometer DNA ploid at 24 h after heat stress induction. Results In the heat shock and cadmium chloride groups,HSP70 expression at each time point and cell apoptosis at 24 h were significantly higher than those of control group(P

Objective To study the risk factors related to recurrence of gastrointestinal stromal tumor (GIST) after discontinuing postoperative adjuvant imatinib mesylate (IM) treatment.Methods We retrospectively analyzed our clinical database of 138 GIST patients who received radical resection and subsequent IM adjuvant treatment at the Renji Hospital,Shanghai Jiaotong University School of Medicine between January 2006 and January 2014.Results For the entire Multivariate analysis study group,the overall 5-year recurrent free survival (RFS) rate was 54.5％.There were two tumor characteristics which were independent prognostic factors of GIST treated by postoperative IM:Ki67 index (P =0.005),and serosal invasion (P =0.026).The accuracy of comprehensive evaluation based on the two weighted variables was better than NIH staging criteria(AUC:0.714 vs.0.631).Furthermore,two risk groups were created according to the risk model with 5-year RFS of 81.3％ and 31.1％ as low-risk and high-risk groups,respectively (P ＜0.05).Conclusions For patients with intermediate or high risk in NIH classification,if there was tumor serosal invasion,or if there was no local invasion but Ki67 index ＞ 8％,extended continuous IM adjuvant treatment should be recommended after the primary tumor was radically resected.

Objective To evaluate the effect of online teaching platform in clinical neurology prac-tice. Methods The participants were medical undergraduate students in the process of clinical practice in Department of Neurology of XiJing hospital, who were divided into the traditional practice teaching group (n=77) and online platform auxiliary practice teaching group (n=90), respectively carry-ing out the corre-sponding rotation practice teaching . Unified objective structured clinical examination was given to two groups of students to implement departmental rotation examination , and investigation was made among teachers and students on the evaluation of the effect of practice. SPSS 19.0 was used to do t test to the two sets of corresponding evaluation data. Results Total score of departmental rotation examination in online platform auxiliary practice teaching group (69.33 ±2.74) was significantly higher than traditional teaching group (67.23±2.50) (P=0.000). Scores of basic theories, skill and operation, clinical case analysis in online platform auxiliary practice teaching group were significantly higher than traditional teaching group (P<0.05). However, medical record writing scores in online platform auxiliary practice teaching group (7.39± 1.09) were significantly lower than the traditional teaching group (8.03±1.03) (P=0.000). Teachers' eval-uation of practice effect was obviously higher in online platform auxiliary practice teaching group (12.33± 0.52) than that in traditional teaching group (10.67 ±1.03) (P=0.005). Students' evaluation of interest in learning, content arrangement, teachers' sense of responsibility, evaluation of teaching ability, practice effect were obviously higher than that of traditional teaching group (P<0.05). Conclusion This study preliminary has achieved good practical effect by using online auxiliary teaching platform, and got high evaluation by both teachers and students. Inter-active communication and sharing of resources is easy in the online plat-form of practice teaching . On-line platform will help students develop with clinical neurology diagnosis thinking.

AlM:To evaluate the efficacy of combined pranoprofen eye drops and artificial tears on the treatment of mild to moderate dry eye syndrome after trabbeculectomy.METHODS:This prospective case control study included 63 cases (63 eyes) of patients with mild to moderate dry eye syndrome after trabbeculectomy in our hospital from November 2013 to June 2013. All subjects were randomly divided into two groups. Observation group was treated with combined pranoprofen eye drops and artificial tears and control group received simple artificial tears marking the eyes at 1, 2, 4wk. The patient's symptoms, signs, BUT, S▏t, and FL were observed before treatment and 1, 2, 4wk after treatment.RESULTS: After 2wk, the symptoms of observation group were improved, there was statistically significant difference (P<0. 05). FL difference of each group was statistically significant ( P<0. 05 ); After 4wk, symptoms and signs were improved. There was statistically significant difference ( P < 0. 05 ). The BUT of the observation group and corneal FL scores of two groups showed significant differences (P<0. 05). CONCLUSlON: Artificial tears joint pranoprofen eye drops has good curative effect in the treatment of mild to moderate dry eye syndrome after trabbeculectomy.