Objective To evaluate the effects of cardiac resynchronization therapy with optimized dynamic AV delay.Methods The study included 63 patients who underwent implantation of biventricular pacemakers for congestive heart failure.The dynamic AV delay was optimized on the day 1 week,6 months and 12 months after pacemaker implantation.The echocardiography and ECG,6MHW,QOL and NYHA grade were evaluated at the same time.Results The best optimized AV delay was between 90 ms and 140 ms(110.45?19.47 ms).Comparing the effectiveness 1 week after CRT with the day before CRT:the LVEF increased from 18.53%?4.83% to 22.07%?6.77% with the QRS interval decreased from 138.25?28.00 ms to 129.40?6.65 ms.Comparing the effectiveness of the day before and in 6-12 months after CRT optimized AV delay,the LVFT increased from 293.27?24.79 ms to 347.57?26.21 ms.There was no difference in QRS intervals.The LVEDD was upgraded from 71.43?7.12 mm to 57.06?6.54 mm while the QOL was upgraded from 74.14?6.24 to 55.15?11.02 and the NHYA upgraded from 3.12?0.55 to 1.82?0.43.Conclusion Optimized dynamic AV delay of the pacemaker parameters enhanced the short-term and long-term efficacy of CRT.

Objective To study the safety and efficacy of laparoscopic splenectomy and portoazygous devascularization for portal hyperteation.Methods The data of 58 patients who underwent laparoscopic splenectomy and portoazygous devascularization were retrospectively collected and analyzed.Results The operative time for laparoscopic splenectomy and portoazygous devascularization was (2.6 ±0.6) hours.The intraoperative bleeding was (149.5 ± 32.7) ml.The time taken for the bowel to return function was 3.5 ±1.3 days.The hospitalization time was (5.1 ± 1.2) days.When the splenic volume was greater than or equal to 1.5 liters, the conversion to open surgery rate significantly increased [36.0％ (5/14);P ＜ 0.05].The 1, 2, 3, and 4 years cumulative recurrent gastrointestinal bleeding rates were 0, 5.2％, 10.0％, and 15.8％, respectively.Conclusions Laparoscopic splenectomy and pericardial devascularization was safe, efficacious and feasible.When the splenic volume was greater than 1.5 L, whether laparoscopic surgery should be attempted requires further research.

ObjectiveTo investigate the features of pulmonary function and influencing factors in patients with cervical spinal cord injury (SCI).MethodsThe pulmonary function data of 48 patients with cervical SCI were analyzed. The correlations between the percent predicted values of vital capacity (VC), maximal voluntary ventilation (MVV), forced expiratory volume of 1st second (FEV1) and V75 (expressed as VC%, MVV%, FEV1%, V75%) and ASIA motor/sensory scores were analyzed. Then, four multiple linear regressions were run to use VC, MVV, FEV1, V75 as an independent variable respectively.ResultsThe percent predicted values of the pulmonary function (VC%, MVV%, FEV1%, V75%) in patients with cervical SCI obviously decreased, which suggested that these patients had a restrictive ventilation disorder. There were significant positive correlations between VC%、FEV1%、V75% and ASIA motor scores (by bivariate correlation tests), no significant correlations between any of pulmonary function parameters and the ASIA sensory scores. Of four linear regression models, the height showed as a protecting factor in 3 linear regression models and weight did in the other one respectively. Of parameters associated with SCI, just ASIA motor scores showed as a protecting factor in 3 linear regression models, no sensory scores or duration appeared in any linear regression models.ConclusionBesides the height and weight, the ASIA motor score is a main factor influencing the pulmonary function.

Vertebral artery hypoplasia is a congenital vessel variation. Its incidence is from 1. 9 to 26. 5% . In recent years, studies have shown that vertebral artery hypoplasia may be a potential risk factor for posterior circulation infarction, especialy when it coexists with other cerebrovascular risk factors. Vertebral artery hypoplasia may also cause regional hypoperfusion and complex neurovascular regulation, and it also has a certaln link with migralne.

In this article we analyzed the current development of moxibustion treating rheumatoid arthritis from the usefulness, advancement, synergistic effect as well as the variance between different kind of moxibustion. We concluded that moxibustion was an effective intervention for treating RA, and the methods used in moxibustion were searched in clinic. But the clinical tralls has a long way to go, we should pay more attention to the critical issues while in the use of moxibustion.

The aim of this work was to investigate guar gum/ethylcellulose mix coated pellets for potential colon-specific drug delivery. The coated pellets, containing 5-fluorouracil as a model drug, were prepared in a fluidized bed coater by spraying the aqueous/ethanol dispersion mixture of guar gum and ethylcellulose. The lag time of drug release and release rate were adjustable by changing the ratio of guar gum to ethylcellulose and coat weight gain. In order to find the optimal coating formulation that was able to achieve drug targeting to the colon, the effect of two independent variables (the ratio of guar gum to ethylcellulose and the coat weight gain) on drug release characteristics was studied using 3×4 factorial design and response surface methodology. Results indicated that drug release rate decreased as the proportion of ethylcellulose in the hybrid coat and the coat weight gain increased. When the ratio of guar gum to ethylcellulose was kept in the range of 0.2 to 0.7, and the coat weight gain in the range of 250% to 500%, the coated pellets can keep intact for about 5 h in upper gastrointestine and achieve colon-specific drug delivery. The pellets prepared under optimal conditions resulted in delayed-release sigmoidal patterns with T5% (time for 5% drug release) of 5.1-7.8 h and T90% (time for 90% drug release) of 9.8-16.3 h. Further more, drug release was accelerated and T90% of the optimum formulation pellets decreased to 9.0-14.5 h in pH 6.5 phosphate buffer with hydrolase. It is concluded that mixed coating of guar gum and ethylcellulose is able to provide protection of the drug load in the upper gastrointestinal tract, while allowing enzymatic breakdown of the hybrid coat to release the drug load in the colon.

ObjectiveTo investigate the changes in liver function and the efficacy of either hand-assisted laparoscopic surgery (HALS) or open splenectomy (OS) in combination with pericardial devascularization in the treatment of portal hypertension. MethodsThe clinical data of 94 patients who received splenectomy combined with pericardial devascularization to treat portal hypertension due to cirrhosis from Jan 2002 to May 2008 were analyzed retrospectively. 56 patients received OS and 38patients HALS. The operating time, intraoperative blood loss, postoperative complications, liver dysfunction and mortality were analyzed according to the Child's grading. ResultsThere was no difference in the operating time between HALS and OS (P＞0. 05). The intraoperative blood loss and postoperative complications were 5.6% and 10.8%, respectively (P＜0. 05). There was no significant difference in the serum ALT between HALS and OS, but there was a significant difference in the ALB (P＜0. 05). The AST also had a significant difference on postoperative day 5 (P＜0. 05). The serum ALT and AST were elevated after HALS, but there was a significant difference only for AST (P＜0.05). The serum ALT and AST in OS were significantly higher after than before operation (P＜0. 05). The serum ALB in OS was significantly lower after operation (P＜0.05), but it was significantly lower only on postoperative days 1 and 3 (P＜0.05) in HALS. ConclusionsCompared with OS, HALS combined with pericardial devascularization caused less damage to the intestinal tract and the liver function. It is a feasible and safe operation and it had fewer postoperative complications.

Objective To report the MRI findings of brain damage obsenrved in neonatal patients who suffered from isolated hypoglycemia and to explore the value of diffusion-weighted imaging(DWI) inearly detection of neonatal hypoglycemic brain iniun,. Methods Twelve neonates with isolated hypoglycemia(10 of the 12 were diagnosed to suffer from hypoglycemic encephalopathy)were enrolled in this study.They were first scanned at age from 3 days to 10 days with Tl WI,T,WI and DWI(b is 0 s/mm2,1000 s/mm2),and 4 of them were then scanned from 7 days to 10 days following the initial scan.All acquired MR images were retrospectively analysed.Results First series of DWl images showed distinct hyperintense signal in 11 cases in several areas including bi lateral occipital cortex(2 cases),right occipital cortex(1 case),left occipital cortex and subcortical white matter(1 case),biIateral occipital cortex and flubcortical white matter(2 cases),bilateral parieto-occipital cortex(2 cases),bilateral parieto-occipital cortex and subcortical white matter(2 cases),the splenium of corpus catlosum(4 cases),bilateral corona radiata(2 cases),left eaudate nucleus and globus pallidus(1 case),bilateral thalamus(1 case),bilaterally posterior limb of internal capsule(1 ease).In the initial T1 WI and T2,WI images,there were subtle hypointensity in the damaged cortical areas(3 cases),hyperintensity in the bilaterally affected occipital cortex(1 case)on T1 weighted images,and hyperintensity in the affected cortex and subcortieal white matter with poor differentiation on T2 weighted images.The followed-up MRI of 4 cases showed regional encephalomalaeia in the affected occipital lobes(4 cases),slightly hyperintensity on T2 weighted images in the damaged occipital cortex(2 cases),extensive demyelination(1 case).disappearance of hyperintensity of the splenium of corpus callosum(1 case),and persistent hyperintensity in the splenium of corpus callosum (1 case)on T2 weighted images.Conclusion The findings suggest that posterior parieto-occipital regions are most frequently injured in neonatal period due to severe hypoglycemia.DWI is a useful technique in the early detection and evaluation of hypoglycemic brain injury of neonates.

Airway Obstruction ; complications ; etiology ; physiopathology ; Asphyxia ; etiology ; physiopathology ; Fibroma ; complications ; pathology ; Humans ; Infant, Newborn ; Oropharyngeal Neoplasms ; complications ; pathology ; Rare Diseases

Objective To study the preliminary effects of percutaneously looped thread transection on the surgical treatment of carpal tunnel syndrome (CTS). Methods A total of 72 cases (103 sides) were treated from January 2012 to Decem?ber 2014 (27 males and 45 females, aged 22-94 years, with an average of 51.3 years). Among all the cases, 21 cases (30 sides) were treated with open decompression and 51 cases (73 sides) were treated with percutaneously looped thread transection. We did the incision in the ulnaris hypothenar pattern, revealed and cut off the transverse carpal ligament to decompress the carpal tunnel in the open surgery. Percutaneously looped thread transection was under the guidance of ultrasound, threading from the deep and shallow transverse carpal ligament, respectively, forming loops to cut off and decompressed the carpal tunnel. We observed the me?dian nerve aspect ratio (the ratio of length to width of the uncinatum median nerve on transverse section) and swelling ratio (the ra?tio of area of median nerve on transverse section of pisiform and distal radius) under ultrasound before, during and 3 months after operation. Telephone follow?up was conducted in postoperative 3 months according to the Boston Carpal Tunnel Questionnaire (BCTQ) to evaluate the symptoms of carpal tunnel syndrome and wrist joint function. Results There were 11 cases lost in the fol?low?up, and 61 cases were followed up for 3 to 27 months, with an average of 11.6 months. The preoperative BCTQ scores of open decompression group and looped thread transection group were 28.5±4.6 and 29.4±5.3, respectively. There was no statistically sig?nificant difference between two groups (t=1.34, P=0.528). The postoperative 3 months BCTQ scores were 16.3±5.7 and 15.7±4.9. There was no statistically significant difference between two groups (t=1.12, P=0.674). The median nerve aspect ratios measured under ultrasound of open decompression group before and 3 months after operation were 3.8 ± 0.7 and 2.6 ± 0.4, respectively. The swelling ratios were 2.3±0.4 and 1.2±0.3. The difference of preoperative and postoperative changes was statistically significant (P<0.05). The median nerve aspect ratios measured under ultrasound of looped thread transection group before and 3 months after op?eration were 3.9±0.6 and 2.7±0.5, respectively. The swelling ratios were 2.1±0.3 and 1.4±0.4. The difference of preoperative and postoperative changes was statistically significant (P<0.05). There were no infection, poor healing, blood vessel and nerve damage after operation in both two groups. Conclusion Percutaneously looped thread transaction under ultrasound for the surgical treat?ment of CTS has less trauma and rapid recovery. It can improve the symptoms of median nerve stimulation, restore the morphology and function of the median nerve and reach the same effects as the open decompression surgery.