OBJECTIVETo investigate the roles of nitric oxide (NO) and eNOS in the pathogenesis of vasovagal syncope (VVS).

METHODSFourteen children with VVS (group A), 10 children with syncope other than vasovagal (group B) and 20 healthy volunteers (group C) were enrolled. Plasma NO levels in groups A and B were determined before and at the termination of the head-up tilt table test (HUT). The G894T polymorphism within the eNOS gene was determined in the three groups.

RESULTSPlasma NO levels in group A increased significantly when syncope attacked from 76.7+/-9.6 micromol/L (before HUT) to 90.0+/-11.4 micromol/L (P<0.05). After the syncope attack was improved, plasma NO level in group A was significantly reduced. There were no statistical differences in plasma NO levels before and after the HUT in group B. Determining the G894T polymorphism within the eNOS gene showed that group A was associated with a higher incidence of the GT gene type as compared to groups B and C (42.9% vs 10%; P<0.05).

CONCLUSIONSPlasma NO may be involved in the pathogenesis of VVS. The increased plasma NO level may be associated with the G894T polymorphism of the eNOS gene.

Child ; Humans ; Nitric Oxide ; blood ; physiology ; Nitric Oxide Synthase Type III ; genetics ; physiology ; Polymorphism, Genetic ; Syncope, Vasovagal ; etiology

BACKGROUND:Intravertebral bone graft to rebuild anterior and middle column structure and to recover vertebral morphology has been re-understood, and a suitable bone graft material can promote bone healing and be conducive to rebuild the long-term stability of the spine. OBJECTIVE:To discuss the differences in clinical efficacy of three kinds of bone graft materials through unilateral pedicle to treat thoracolumbar burst fractures. METHODS:Total y 102 thoracolumbar burst fracture patients were randomized into three groups:autologous bone, autologous bone combined with al ogeneic bone and al ogeneic bone were implanted via the unilateral pedicle, respectively, in the three groups. We measured the percentage of height of the anterior edge of vertebral body and Cobb angle by X-Ray before and after bone grafting, and used CT to observe bone graft healing, and used Mimics to measure the defect area of vertebral body at the last fol ow-up. RESULTS AND CONCLUSION:Al the 102 patients were fol owed-up for 24-36 months. The percentage of height of the anterior edge of vertebral body and Cobb angle of three groups were restored after bone grafting (P<0.05), but there was no difference in the percentage of height of the anterior edge of vertebral body of three groups at different time point after bone grafting. The Cobb angle in the al ogeneic bone group was bigger than that in the autologous bone group and autologous bone combined with al ogeneic bone group at 9, 12 and 24 months after bone grafting (P<0.05). The fracture healing rate of the al ogeneic bone group at different time points was lower than that of the autologous bone group and autologous bone combined with al ogeneic bone group (P<0.05), and the area of bone defect was bigger than that in the autologous bone group and autologous bone combined with al ogeneic bone group (P<0.05). These findings indicate that these three bone graft materials can rebuild the vertebral body via the unilateral pedicle to treat thoracolumbar burst fracture, reduce the loss of vertebral height and Cobb angle, and decrease defect area of the vertebral body. The clinical efficacy of autologous bone combined with al ogeneic bone to heal bone graft and reduce bone defect is similar to autologous bone, both of which are better than al ogeneic bone alone.

Objective To observe the different changes of macular microstructure in patients with large idiopathic macular hole (IMH) treated with vitrectomy combined with internal limiting membrane (ILM) transplantation or not.Methods Forty eyes in 40 consecutive patients with giant IMH (≥500 μm) were included in the study.Twenty eyes received vitrectomy with ILM transplantation (ILM transplantation group) and others with ILM peel off (ILM removal group).During the operation,a proper size of the ILM was removed and filled in the bottom of the macular hole.The age,duration of disease and the ocular laterality of the two groups of patients were not statistically significant (P＞0.05).Minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (SD-OCT) scan were examined.There was no statistically significant difference in logMAR BCVA,average defect diameter of photoreceptor ellipsoid (IS/OS) and average defect diameter of external limiting membrane (ELM) between two groups (t=0.128,1.452,1.321;P＞0.05).The logMAR BCVA and SD-OCT were examined on 1,3,6,12 months postoperatively.Results On 1 month after the surgery,there was no statistically significant difference in logMAR BCVA,average defect diameter of IS/OS and average defect diameter of ELM between two groups (t=1.226,1.435,1.018;P＞0.05).On 3,6,12 months after the surgery,compared with ILM removal group,the logMAR BCVA (t=2.059,2.871,2.415) increased and the average defect diameter of IS/OS (t =2.070,2.110,2.121) and ELM (t =2.034,3.647,3.556) significantly reduced in ILM transplantation group (P＜0.05).On 1 month after the surgery,there was statistically significant difference in CRT between two groups (t=2.113,P＜0.05).On 3,6,12 months after the surgery,there was no statistically significant difference in CRT between two groups (t=0.428,0.847,0.849;P＞0.05).Conclusion Compared with vitrectomy combined with ILM peeling surgery,the diameter of IS/OS and ELM defect were significantly decreased after vitrectomy combined with ILM transplantation in the patients with large IMH.

Objective:To systematically evaluate the efficacy and safety of neoadjuvant chemoradiotherapy (NCRT) plus surgery versus neoadjuvant chemotherapy (NCT) plus surgery in the treatment of advanced esophageal squamous cell carcinoma.Methods:Clinical controlled trials of comparing the treatment of NCRT plus surgery with NCT plus surgery for esophageal squamous cell carcinoma were electronically searched from the databases including PubMed, The Cochrane Library, EMbase, CBM, CNKI, WanFang and VIP from the inception of databases to January, 2019. Two reviewers independently screened the literatures, extracted data and assessed the risk of bias of the included studies. And then, a meta-analysis was performed by using RevMan 5.3 software.Results:A total of 8 clinical control studies were included, including 995 patients with esophageal squamous cell carcinoma. Meta-analysis results showed that compared with the NCT group, the R 0 resection rate was significantly higher ( OR=2.14, 95% CI: 1.03-4.45, P=0.040) and the pathological complete response (pCR) rate was significantly higher ( OR=4.19, 95% CI: 1.71-10.28, P=0.002) in the NCRT group. The incidence of postoperative complications ( OR=1.37, 95% CI: 0.76-2.48, P=0.300) and the risk of perioperative death ( OR=1.28, 95% CI: 0.58-2.83, P=0.54) were not significantly different between two groups. The long-term survival of patients with esophageal squamous cell carcinoma in the NCRT group was significantly better compared with that in the NCT group ( HR=0.77, 95% CI: 0.64-0.92, P=0.005). Conclusions:Compared with NCT plus surgery for advanced esophageal squamous cell carcinoma, NCRT plus surgery has higher R 0 resection rate and pCR rate, does not significantly increase the risk of perioperative complications or perioperative death, and significantly improves the long-term survival of esophageal squamous cell carcinoma patients.

Objective To investigate the imaging diagnosis of acetabular dysplastic coxarthrosis. Method The imaging of the acetabular dysplasia was analyzed in 51 patients (87 hips). All but four patients were women. The age ranged from 22 to 78 years, and the mean age was 42.6 years. Pelvis radiographs were studied in all cases, and CT scan was performed in 18 cases and MRI in 10 cases. Results The fundamental signs on the plain film included shallow acetabulum, increased obliquity and insufficient coverage of the femoral head by the acetabulum. The CE angles were determined in all the cases, ranging from -10? to 30?, mean 12.9?. The charp angles ranged from 35? to 67?, mean 45.3?. The secondary osteoarthritis were revealed in 75 hips (84.2%). 54 hips (62.1%) had cyst like lesions in weight bear area of the acetabulum or femoral head. 19 hips had subluxation of femoral head. CT and MRI displayed small cystlike lesions and forward shift of the femoral head, which could not be shown on plain film, respectivly in 13 and 10 hips. Conclusion The cyst like lesion of subarticular region is a common sign in acetabular dysplastic coxarthrosis. CT or MRI can show the early osteolytic lesion and forward subluxations.

OBJECTIVETo discuss the avail of balloon and stent-assisted Guglielmi detachable coil (GDC) placement in treatment of wide-necked cerebral aneurysm.

METHODSEighty-seven patients with 92 wide-necked aneurysms undergone endovascular procedures using the balloon and stent-assisted remodeling technique. Respectively, appropriate Neuroform stents delivered with a 5 mm landing zone on either side of the aneurysm neck, the microcatheter entered through the interstice, aneurysms were embolized at one or several times. Two catheters were used in balloon-remodeling technique, balloon were inflated across the neck of the aneurysms after the microcatheter entering the aneurysms, then the GDC were used to embolize the aneurysms.

RESULTSThirty-one aneurysms were completely occluded, 3 subtotally (> 90%) and 1 incompletely (70% - 90%) occluded using stent-assisted technique, all carry arteries were unblocked, 3 patients with mild neurological dysfunction and no mortality. Fifty aneurysms were completely occluded and 4 incompletely occluded using balloon-assisted technique, 1 patients with mild neurological dysfunction and no mortality. Two aneurysms were completely occluded and 1 incompletely occluded using stent-assisted and balloon-assisted technique. The mean period of follow-up was 5.8 months. Rates of recanalization were 16.7% for stent-remodeling group and 12.5% for balloon-remodeling group.

CONCLUSIONSThe stent and balloon-assisted remodeling technique are safe and effective in treating wide-necked aneurysms. Balloon-remodeling technique has more security comparing with stents.

Angioplasty, Balloon ; Embolization, Therapeutic ; methods ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Treatment Outcome

OBJECTIVETo screen the mutation of the beta and gamma subunits of epithelial sodium channel gene SCNN1 in two families with Liddle's syndrome.

METHODSTwo patients clinically diagnosed as Liddle's syndrome and their family members were enrolled. Peripheral blood samples were collected and total genomic DNA was prepared. Polymerase chain reaction (PCR) was used to amplify the exon 13 of the SCNN1B and SCNN1G gene. PCR products were purified and subjected to direct DNA sequencing.

RESULTSA heterozygous nonsense mutation at codon 564 of the SCNN1B gene from CGA(Arg) to stop codon(TGA) was detector in the proband of family 1. More importantly, a novel heterozygous nonsense mutation of CAG(Gln) to stop codon TAG at codon 567 of the SCNN1G gene was detected in the proband and another two members of family 2.

CONCLUSIONScreening for specific mutations of the SCNN1 gene in relatives of patients with Liddle's syndrome can be used to identify the previously unrecognized cases within the family. A new nonsense mutation(Q567X) of the SCNN1G gene is likely the cause of Liddle's syndrome in family 2.

Adult ; Asian Continental Ancestry Group ; genetics ; Base Sequence ; Case-Control Studies ; DNA Mutational Analysis ; Epithelial Sodium Channels ; genetics ; Female ; Humans ; Liddle Syndrome ; genetics ; Male ; Mutation ; genetics ; Pedigree ; Young Adult

OBJECTIVETo observe the alteration of fibroblast growth factor 10 (Fgf10) and fibroblast growth factor receptor 2 (Fgfr2b) signal in mouse embryonic palate after dexamethasone and vitamin B12 exposure.

METHODSDams were divided teratogenetic group, antagomistic group and control group and were respectively injected dexamethasone, dexamethasone and vitamin B12, and normal sodium. Dams were killed and fetus was collected at embryo 12.5 and 13.5 day. The expression of Fgf10 and Fgfr2b and mesenchymal cells proliferation of mouse embryonic by western blotting and BrdU assay were checked.

RESULTSFgf10 and Fgfr2b expression was down-regulated and mesenchymal cells proliferation was inhibited significantly after dexamethasone exposure. After vitamin B12 treatment, Fgf10 and Fgfr2b expression did not restore, but cells proliferation was recovered.

CONCLUSIONDexamethasone and vitamin B12 affected the expression of Fgf10 and Fgfr2b of mouse embryonic palate and mesenchyme cells proliferation, but the change was disaccord.

Animals ; Cell Proliferation ; Dexamethasone ; Fibroblast Growth Factor 10 ; Mice ; Receptor, Fibroblast Growth Factor, Type 2 ; Signal Transduction ; Vitamin B 12

OBJECTIVETo investigate effects of low-dose cyclophosphamide and prednisone (CP) metronomic chemotherapy on microvessel density of bone marrow, serum vascular endothelial growth factor (VEGF) and platelet derived growth factor BB (PDGF-BB)in multiple myeloma (MM) patients.

METHODS54 refractory or relapsed MM patients were treated with CP metronomic chemotherapy consisted of oral cyclophosphamide (CTX, 50 mg/d) and prednisone (Pred, 15 mg/d). Bone marrow and peripheral blood of each patient were collected before and 2, 4, 6 months after treatment. Among the 37 assessable patients, 30 cases were responsive with the response rate of 81.08%. Another 17 cases were follow-uped less than 6 months or failure to obtain serum samples or lost to follow-up. Microvessel density of bone marrow was measured by immunohistochemistry and serum VEGF/PDGF-BB expression was analyzed by ELISA in the 37 assessable patients.

RESULTS2, 4, 6 months following CP metronomic chemotherapy, microvessel densities of bone marrow in the responders were 33.1 ± 4.8/HP, 24.8 ± 3.7/HP, 19.7 ± 2.1/HP respectively; the expressions of VEGF were (394 ± 57) ng/L, (268 ± 32) ng/L and (217 ± 20) ng/L respectively; the expressions of PDGF-BB were (304 ± 31) ng/L, (274 ± 31) ng/L and (196 ± 22) ng/L respectively. After CP metronomic chemotherapy, there were significantly lower of microvessel density, VEGF and PDGF-BB levels than pretreatment \[MVD 48.5 ± 5.9/HP, VEGF (517 ± 60) ng/L, PDGF-BB (484 ± 60) ng/L\]in the responders (P < 0.01). While in the non-responders, after treated by CP metronomic chemotherapy for 2 months, microvessel density, the expression of VEGF and the expression of PDGF-BB were 32.5 ± 4.7/HP, 512 ± 39 ng/L and (452 ± 39) ng/L respectively. There were no significant changes of MVD, VEGF and PDGF-BB levels compared with pretreatment \[MVD 33.2 ± 5.6/HP,VEGF (498 ± 55) ng/L, PDGF-BB (488 ± 44) ng/L\] (P > 0.05).

CONCLUSIONSOur findings suggested that continuous low-dose CP metronomic chemotherapy could decrease microvessel density of bone marrow in MM patients. Furthermore, it down-regulated expression of serum VEGF and PDGF-BB to exert its anti-angiogenesis in MM.

Aged ; Aged, 80 and over ; Angiogenesis Inhibitors ; administration & dosage ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; administration & dosage ; Female ; Humans ; Male ; Microvessels ; drug effects ; Middle Aged ; Multiple Myeloma ; blood ; blood supply ; drug therapy ; Prednisone ; administration & dosage ; Proto-Oncogene Proteins c-sis ; blood ; Vascular Endothelial Growth Factor A ; blood

OBJECTIVETo assess the methodology and report quality of systematic evaluation and Meta-analysis of acupuncture and moxibustion in China.

METHODSRetrieve CBM, CNKI, WF and VIP database, collect data from the information system established by Epidata 2.1, assess the methodology and report quality by using the QQAQ and QUOROM, calculate the percentage of adequate rate.

RESULTSThirty-eight reviews, including twenty six systematic evaluation and twelve Meta-analyses, met the enrolled criteria. Twenty-two kinds of diseases and six diseases systems were included. The methodology quality scores were generally low (3.34 +/- 1.44). The causes of the problems were insufficient literature resource, bias in data collections and inaccurate merging methods. The report quality was relatively low in abstracts, methods, trial flow, introduction and data merging.

CONCLUSIONThe amount of literatures on systematic evaluation and Meta-analysis of acupuncture is gradually increasing from 2002. However, the quality control is not ideal. It is important to improve the methodology and report quality.

Acupuncture Therapy ; methods ; China ; Moxibustion ; methods