Electrical stimulation is a common technology to treat neurogenic bladder dysfunction secondary to supersacral spinal cord injury. This paper reviews the historical development of this treatment and current status.

Objective To evaluate the application of video-assisted thoracoscopic surgery (VATS) in the treatment of traumatic hemothorax. Methods We performed VATS in 60 cases of traumatic hemothorax with medium amount of bleeding or above from March 2000 to March 2004, including 12 cases accompanying the prodrome of shock and 6 cases associated with injuries of liver or spleen. Unilateral VATS was carried out in 48 cases, all of which were completed under thoracoscope except 3 cases of heart injuries were supplemented with mini-incision repair. Bilateral VATS was conducted in 6 cases and the combination of thoracoscopy with laparoscopy was required in 6 cases. Results The operation time was 45～175 min (mean, 105 min) and the postoperative hospital stay was 7～13 days (mean, 11 days). No complication occurred. Conclusions VATS in the management of traumatic hemothorax is safe, effective and minimally invasive, with a relatively short operation time and quick recovery.

Objective To investigate the global and regional dyssynchrony of left ventricle in patients with coronary artery disease before and after revascularization by tissue synchronization imaging(TSI).Methods Subjects with the left anterior descending coronary artery(LAD)stenosis＞75% who underwent revascularization(n=26)and normal controls(n=30)were studied with TSI.Echocardiography was performed one day before revascularization,then repeated one month and three month after the operation,respectively.The sample volumes were located at the mid-myocardium of base and middle segments in apical four-,two- and three-chamber view of left ventricle.The time-to-peak velocity(Tp)of all myocardial segments were examined to access the regional dyssynchrony,and the standard deviations of Tp of 12 segments(TSD)were calculated to evaluate the global dyssynchrony.Results Before revascularization,Tp of segments in the anterior wall and the interventricutar septum in patients were more delayed than those of control group(P＜0.01),and the color coding of ischemic segments were red and yellow.After operation,Tp of delayed segments were significant improved,and the color coding turn to yellow or even green,but there was still significant difference of Tp between disease group and control group(P＜0.01 or P＜0.05).TSD decreased gradually on the preoperatative,early postoperative,and later postoperative echocardiogram,and it on each time point of the disease group were all longer than that of control group.An improvement of TSD was observed after revascularization,especially for the three month examination(P＜0.01),but the difference between early and later postoperation was not significant(P＞0.05).Conclusions The asynchronous motion of LV is very obvious in CAD patients.After revascularization,both global and regional dyssynchrony were improved gradually.Moreover,TSI is a convenient and non-invasive way to quantitate left ventricular asynchrony with the parameters.

Objective To explore the differential diagnostic value of speckle-tracking imaging (STI) between dilated cardiomyopathy(DCM) and ischemic cardiomyopathy(ICM).Methods 40 DCM patients,32 ICM patients and 30 normal controls were enrolled for this study.Different views of high frame images of left ventricle were recorded.The time to peak radial strain,circumferential strain and longitudinal strain of 18 myocardial segments were measured by STI,and the maximum differential (Ts-dif) and the standard deviation(Ts-SD) of time to the peak strain were calculated.The left ventricular parameters measured by STI were compared between DCM and ICM,and the diagnostic sensitivity and specificity were investigated by the areas under the receiver operating characteristic (ROC) curves.Results Parameters of different segments of ICM were obviously higher than those of DCM (P ＜ 0.05),and there were significant differences between ICM and DCM.The areas under the ROC curves of Ts-dif and Ts-SD to radial strain were 0.920 and 0.946 respectively.At the cut off of 170 ms and 53 ms for diagnosing DCM and ICM,the sensitivity,specificity and accuracy were 87.5％,87.5％,87.5％ and 90.6％,90％,90.2％ respectively.Conclusions These strain parameters by STI,especially Ts-SD to peak strain can offer a new quantitative diagnostic method in distinguishing DCM from ICM.

Objective To evaluate the overall failure rate of one or two-stage exchange arthroplasty for infections in total knee arthroplasty (TKA) and the predictors affecting the outcome of exchange.Methods Thirty-nine cases received one or two-stage exchange arthroplasty for periprosthetic joint infections after primary TKA in Shanghai Sixth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Southeast Hospital affiliated to Xiamen University from January 2012 to November 2014 were reviewed.Periprosthetic tissue and articular fluid of all patients were analyzed by bacterial culture.All patients were followed up for more than one year.C-reactive protein (CRP),erythrocyte sedimentation rate (ESR),procalcitonin (PCT) and blood routine were tested every four weeks,and the evaluation on pain,total periprosthetic function,range of motion and deformation of arthroplasty were conducted.Differences between groups were analyzed using chi-square test or Student's t test when appropriate.A stepwise selection approach in logistic regression analysis was used to screen key predictors for outcome of one or two-stage exchange for infections in TKA.Results There were 39 patients who had undergone one or two-stage exchange for infections in TKA,including 20 males (51.3％) and 19 females (48.7％) with an average age of (62.4±11.7) years.Among the 39 patients,18 gram-positive strains were isolated from specimens,and 6 gram negative strains,2 Mycobacterium tuberculosis and 1 candida albicans.Ten of 39 reimplantations developed reinfection.Between the success and failure groups,there were significant differences in the time from primary TKA to revision (P =0.023),operative time (P =0.029),multidrug resistant organisms (P =0.045),the preoperative and post-operative ESR (P=0.002 and P＜0.001,respectively) and post-operative CRP (P=0.018).Multivariable logistic regression analysis demonstrated that time from primary TKA to revision (OR =0.96,95％CI:0.92-1.00,P=0.025),preoperative ESR (OR=0.97,95％CI:0.95-1.00,P=0.045) and post-operative ESR (OR =0.94,95％ CI:0.91-0.98,P =0.002) were independent indicators associated with the outcome of one or two-stage revision.Conclusions The failure rate after revision for infected TKA is relatively high.The time from primary TKA to revision,preoperative and post-operative ESR could predict the outcome of one or two-stage revision effectively.

Objective To compare the efficacy and safety of novorapid and novolin R in the treatment of patients with gestational diabetes.Methods From September 2014 to October 2015,the clinical data of 58 patients with gestational diabetes in our hospital were retrospectively analyzed.According to the drug used,the patients were divided into two groups.The observation group was given novorapid,and the control group was given novolin R.Before and after treatment,the total effective rate,fasting blood glucose (FBG),2h postprandial blood glucose (2hPBG),average blood glucose control time,body mass index (BMI),alanine transaminase (ALT),aspartate aminotransferase (AST),serum creatinine (SCr),urea nitrogen (BUN) and the frequency of hypoglycaemia,insulin dosage,the pregnancy outcome were compared between the two groups.Results After treatment,the FBG [(5.14±0.39)mmol/L],2hPBG[(7.06±1.25)mmol/L] of the observation group were significantly lower than those of the control group (t=11.72,5.67,all P＜0.05).ALT[(25.27±8.71)U/L],AST[(27.98±8.53)U/L],SCr[(69.92±11.39)μmol/L],BUN[(5.23±5.75)mmol/L] of the observation group had no obvious differences compared with the control group (t=0.14,0.07,0.04,0.30,all P＞0.05).The total effective rate (93.10％),average blood glucose control time (3.06±0.43)d,insulin dosage (36.15±4.72)U/d of the observation group were significantly better than those of the control group (χ2=4.35,t=14.30,4.92,all P＜0.05).The incidence rates of pregnancy-induced hypertension (3.45％),amniotic fluid (6.90％),cesarean delivery (17.24％),macrosomia(3.45％),high blood bilirubin(3.45％) of the observation group were significantly lower than those of the control group(χ2=5.22,5.50,4.08,9.09,7.73,all P＜0.05).Body weight [(70.6±3.09)g],BMI[(23.9±0.28)kg/m2] of the observation group were better than those of the control group(t=2.20,12.19,all P＜0.05).The incidence rate of hypoglycemic events in observation group(17.24％) was significantly lower than that of the control group(χ2=5.47,P＜0.05).Conclusion Compare with novolin R,the treatment effect of novorapid for gestational diabetes is remarkable and has high security,it is worthy of clinical implementation.

Objective To explore a new pathogenic gene mutationin in COL4A3 and COL4A4 genes of a family with thin-basement-membrane nephropathy (TBMN), and explain its mechanism.Methods Genomic DNA was extracted from blood samples.Mutation screening for all the exons in COL4A3 and COL4A4 of the proband was carried out by direct PCR sequencing.The sequences of the proband were compared with standard sequences in GenBank.After identifying the mutation in COL4A4, screening for the mutation site in 200 healthy controls and the rest of family members were conducted.RNA sequence of the proband was analyzed by reverse transcription PCR and TA cloning.The positive clones were sequenced for RNA screening.Results There was a G to A mutation in the 1459 site of COL4A4 (c.1459+G ＞ A) in the proband, her mother, and the elder sister, whereas the mutation was not found in other family members and healthy people.RNA screening showed that the COL4A4 (c.1459+G ＞ A) mutation was a heterozygous substitution in position + 1 of exon 21, in the splicing region.This mutation leaded to eliminating of exon 21 from the COL4A4 mRNA, causing the exon 21 deletion and frameshift mutation following the exon 20 in its amino acids sequence.Conclusions It is described that COL4A4 (c.1459+G ＞ A) is a new pathogenic mutation in TBMN, which further help understanding the pathogenesis and clinical diagnosis of TBMN.

Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in evaluation of the protective effect of edaravone injection in rabbit skeletal muscle ischemia-reperfusion injury.Methods Thirty healthy New Zealand white rabbits were established a model of skeletal muscle ischemia-reperfusion injury in left hind limb and randomly divided into the experimental group and control group.Edaravone was injected with the dose of 1.5 mg/kg at the time of 30 minutes before reperfusion in the experimental group,the control group were given an equal volume of physiological saline.Blood samples were collected respectively at the times of pre-ischemia,post-ischemia and 24 hours after reperfusion for detecting creatine kinase(CK),lactic dehydrogenase(LDH),and CEUS parameters such as peak intensity(PI),time to peak (TTP) and area under the curve(AUC) were measured at the same time.Pathological examination was carried out after the rabbits were sacrificed.Results ①Serological tests:compared to before the blocking of blood supply,the content of CK and LDH after the blocking were significantly increased (P ＜ 0.01);compared to before or after the blocking,the content of CK and LDH at the time of 24 hours after reperfusion in the two groups were increased,and was lower in the experimental group than the control group.(②CEUS:compared to before the blocking,PI,TTP and AUC in each group were significantly increased after the blocking and at the time of 24 hours after reperfusion(P ＜0.01);compared to those in the control group,PI and AUC in the experimental group were decreased at the time of 24 hours after reperfusion,but there was no significant difference in TTP(P ＞0.05).③Correlation analysis:there was a good correlation between PI,AUC and CK,LDH (r =0.87,0.81,0.86,and 0.80,respectively).④Pathological analysis:muscle fibers were swelling with no stripes,partial fractures and interstitial edema and a large amount of inflammatory cells were infiltrated in the control group,while muscle fibers were almost normal with a small amount of inflammatory cells infiltrated in the experimental group.Conclusions Edaravone injection before reperfusion can obviously improve rabbit skeletal muscle ischemia-reperfusion injury,and CEUS can be used to observe these changes directly and effectively.

ObjectiveTo evaluate regional and global systolic function of left ventricle (LV) after mitral valve replacement(MVR) of different methods by 2-dimensional strain (2DS).MethodsAccording to the operational method whether preserve the posterior leaflet and its subvalvular apparatus,48 patients who underwent MVR were divided into two groups,the preservation group (group A) and the resection group (group B).Echocardiography was examinated before and after MVR and the apical four-chamber view,two-chamber view and long-axis view of LV were acquired.Regional peak strain (Sp) and global strain (GS) of LV longitudinal movement were analysed by 2DS software.Results①Compared to preoperation,the Sp in basal segment of posterior septum and inferior wall and middle segment of lateral wall in group A increased significantly ( P ＜0.01 or P ＜0.05).The Sp of group B were improved in both basal and middle segments of posterior septum ( P ＜0.05),while declined in middle segment of lateral wall and anterior wall,basal segment of lateral wall and apical segment of anterior wall significantly (P ＜0.01 or P ＜0.05).②Compared with group A,subtractions between preoperative and postoperative Sp of group B decreased in middle segment and apical segment of anterior wall,middle segment of lateral wall and middle segment of inferior wall significantly ( P ＜0.01 or P ＜0.05).③The GS of group A increased significantly ( P ＜0.05),while that in group B tended to reduce with no statistical significance ( P ＞0.05).Compared with group A,subtractions between preoperative and postoperative GS of group B droped significantly (P ＜ 0.05).ConclusionsAppropriate preservation of the posterior leaflet and its subvalvular apparatus has morebeneficial effect in improving the early regional and global function of LV after surgery,which would be recommended in MVR.Early regional and global systolic function of LV after MVR could be accurately evaluated by 2DS relatively,which has the application value of guiding clinical treatment and estimating prognosis.

Objective To update the knowledge on the sensitizing drugs and clinical features of drug eruption. Methods The clinical data on 138 patients hospitalized for drug eruption in the Department of Dermatology, Institute of Dermatology, Chinese Academy of Medical Sciences, from January 2005 to June 2007, were collected and retrospectively analyzed. Results Totally, 178 episodes of drug eruption were observed in these patients during the tested period. The major sensitizing drugs included antibacterial agents (31.46%), non-steroidal anti-inflammatory drugs (28.09%), traditional Chinese medicines (15.73%). Amoxicillin triggered 20 episodes of drug eruption and was the most common causative drug. Oral administration was the predominant sensitizing route of administration (54.17%). Of all the drug eruptions, 33.71% manifested by erythema multiforme, 28.09% by fixed drug eruption, 22.47% by exanthematous drug eruption. Severe types of drug eruption were mainly caused by traditional Chinese medicines and anti-gout drugs. Conclusions Antibacterial agents and non-steroidal anti-inflammatory drugs have become the major sensitizing drugs of drug eruption, especially amoxicillin. The frequency of traditional Chinese medicine-induced eruptions are increasing. Furthermore, caution is warranted for the drug eruption caused by oral administration.