Objective To evaluate the effect of curing achalasia by transabdominally Heller-Dor operation. Methods To summarize 33 cases of achalasia treated by transabdominally Heller-Dor procedure and visit them postoperatvely. 18 patients receive pre- and post-operativemanometry and 24-hour-pH monitoring. The parameters including reflux frequency 、the longest lasting-time of reflux 、the total time(min) of pH ＜4.0 and the percentage( % ) of time of pH ＜4.0 were recorded and compared using statistical mothods. Results Symptom was significantly improved in 32 patients after surgery, while 1 patient remained dysphasia as pre-operative. The LESP, the reflux frequency、the longest lasting-time of reflux 、the total time(min) of pH ＜ 4.0 and the percentage ( % ) of time of pH ＜ 4.0 also declined after operations ( P ＜ 0. 05 ). 30 patients were followed up,22 (73.3% ,22/30) were cured and 8 had mild sypmtom. Reflux did not detected in 3 cases( 16.7% ,3/18 ) with preoperative reflux. Conclusion Transabdominally Heller-Dor operation could dramadically alleviate the symptoms of patients with achalasia, moreover, it could especially prevent the postoperative-reflux, and with the advantages of simple operations, little traumas.

BACKGROUND:Osteoarthritis and osteoporosis are two aging-related degenerative diseases. There are a lot of studies on their correlation, but no consensus has been reached yet. OBJECTIVE: To examine the cross-sectional association between phalangeal bone mineral density and radiographic knee osteoarthritis. METHODS:A total of 2 855 participants were included in this study. Phalangeal bone mineral density and anteroposterior films of the bilateral knees were detected. A multivariable logistic analysis model was applied to test the relationship between phalangeal bone mineral density and radiographic knee osteoarthritis after adjusting a number of potential confounding factors. RESULTS AND CONCLUSION:A positive association was observed between phalangeal bone mineral density and radiographic knee osteoarthritis in the model that was adjusted for sex, age, bone mass index, smoking status, alcohol drinking status, total energy intake, mean calcium intake, as wel as vitamin and Ca supplementation. This association existed in the total sample and the female subgroup, but not in the male. These findings suggest a positive relationship between phalangeal bone mineral density and radiographic knee osteoarthritis in the female subgroup, which means that bone mineral density is a protective factor to knee osteoarthritis.

Objective To check the teaching effect of whole English presentation for surgery course.Methods Totally 29 eight-year program clinical majors were enrolled in the study.Questionnaire after class was conducted.Relationship between understanding level and English ability of students,abroad experiences,presentation ability or technical title of teachers was analyzed by x-test and nonparametric test.Results It showed that the understanding level of students was higher when being taught by teachers with longer abroad experience or with quality course (P =0.00).Understanding level of students was higher when students had higher English ability (P =0.00).There was no obvious relationships between understanding level and technical title of teachers (P =0.10).Conclusions Teaching effect of whole English presentation is closely correlated with teachers' teaching ability and students' English ability.

BACKGROUND:Extensive studies have shown that transcutaneous electrical nerve stimulation (TENS) plays a positive role in relieving the pain caused by a variety of diseases. However, its exact effect to manage pain in patients with knee osteoarthritis is stil controversial. TENS is classified into h-TENS and l-TENS, but currently its respective role in relieving the pain caused by knee osteoarthritis is not clear yet. OBJECTIVE: To compare the efficacy of h-TENS and l-TENS on pain relieving among patients with knee osteoarthritis. METHODS: A computer-based search was performed on PubMed, Embase and Cochrane database for randomized controled trials on TENS for the treatment of knee pain in patients with knee osteoarthritis which were reported before February 2014. Methodology quality of the trials was criticaly assessed and relative data were extracted. These studies were selected independently by two reviewers according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman5.2 software. RESULTS AND CONCLUSION:A total of 10 randomized controled trials involving 519 cases were included. The results of meta-analysis showed that the h-TENS group had significant effects on pain relief in knee osteoarthritis patients in comparison to the control group [MD=-0.56, 95%CI(-0.98,-0.15),P=0.008]; the l-TENS group had no significant effect on pain relief in knee osteoarthritis patients in comparison to the control group [MD=-0.13, 95%CI(-1.63, 1.38),P=0.87]; the h-TENS group had significant effect on pain relief in knee osteoarthritis patients in comparison to the l-TENS group [MD=-0.85, 95%CI(-1.32, -0.37), P=0.000 5]. These findings indicate that h-TENS performs something positive to reduce pain in knee osteoarthritis patients that l-TENS cannot do. Owing to the limitations of this study, further work is needed to determine the role of TENS in pain management among patients with knee osteoarthritis.

Objective To evaluate the short-term efficacy of cardiac resynchronization therapy(CRT)by three-dimensional speckle tracking imaging (3D-STI).Methods 27 chronic heart failure patients who underwent CRT were enrolled.All following indices were measured respectively:the left ventricular systolic function indices in the 16 segments of 3D-STI including the mean area peak strain,the mean longitudinal peak strain,the mean circumferential peak strain,and the mean radial peak strain(MAS,MLS,MCS,MRS) ; the strain-derived dyssynchrony indices in the 16 segments of 3D-STI including the standard deviation for time to peak area strain,the standard deviation for time to peak longitudinal strain,the standard deviation for time to peak circumferential strain,and the standard deviation for time to peak radial strain (TAS-SD,TCS-SD,TLS-SD,TRS-SD) ;the standard deviation for time to peak area strain,the standard deviation for time to peak circumferential strain,the standard deviation for time to peak longitudinal strain,and the standard deviation for time to peak radial strain(TAS-dif,TCS-dif,TLS-dif,TRS-dif) ;the rotation and twist index of 3D-STI including peak rotation on apical plane,peak rotation on basal plane,peak twist angle(RotA,RotB,Twist),time to peak of the rotation on apical,time to peak of the rotation on bastal,time to peak of the twist (PTRotA,PTRotB,PTtw).The differences of all the indices between before CRT and 3 months after CRT were calculated and the correlation between the changes of all those indices and the changes of left ventricular ejection fraction (△LVEF) were analyzed.Results MAS,MLS,MCS,MRS,RotA and Twist were increased 3 months after CRT (P ＜0.01,P ＜0.05,P ＜0.01,P ＜0.01,P＜ 0.01,P ＜0.01);TRS-SD and PTtw was decreased 3 months after CRT (P ＜0.01,P ＜0.05) ; |△MAS|,| △MLS|,△TRSSD,△RotA and △Twist were correlated with △LVEF 3 months after CRT (r =0.521,P =0.005; r =0.389,P =0.045; r =-0.560,P =0.002; r =0.513,P =0.006; r =0.610,P =0.001).Conclusions The myocardial systolic strain function,dyssynchrony and twist function of left ventricle were improved significantly 3 months after CRT.3D-STI offered a new way for the evaluation of short-term efficacy of CRT.

ObjectiveTo establish rat model of traumatic brain injury combined with hemorrhagic shock.Methods Rat models of traumatic brain injury (produced by free fall impact method) combined with hemorrhagic shock (produced by venous injury method) were established and the related physiological parameters were recorded.The neurological impairment score,cerebral edema degree and blood brain barrier (BBB) were determined by using neurofunction scales,dry-wet method and Evans blue (EB) respectively.HE staining and immunohistochemical staining were applied to evaluate the pathological changes in brain sections.ResultsBlood pressure dropped from 95 mm Hg to 25 mm Hg within three minutes after modeling and maintained around 60 mm Hg one hour later.Neurological impairment score was increased dramatically.The ratio of water content in the brain tissue was elevated nearly from 77％ to 81％.The concentration of EB residual in the brain tissue was increased more than one fold.Neuronal pathological abnormalities,including neuron shrinking,dark eosinophilic staining,perineuronal vacuole in HE staining,and positive staining of β-amyloid precursor protein (β-APP) in immunohistochemical staining were also observed. ConclusionsRat models of traumatic brain injury combined with hemorrhagic shock are successfully established.In addition,the main pathological changes,such as cerebral edema,disruption of BBB,neuron damage,and expression of β-APP are replicated.

BACKGROUND:Pain after arthroscopic treatment can not only affect the patient’s life quality, and is not
conducive to the early reasonable exercise and functional recovery of the patients after treatment. Up to 2012, there are 18 randomized placebo-control ed trials on intra-articular injection of bupivacaine for analgesia after arthroscopic surgery, but the results are different.
OBJECTIVE:To examine the efficacy and safety of intra-articular injection of bupivacaine in the management of pain after arthroscopic surgery through randomized placebo-control ed trials.
METHODS:The MEDLINE database, Cochrane Central Register and Google Scholar database were retrieved for the randomized control ed trials on intra-articular injection of bupivacaine in the management of pain after
arthroscopic surgery up to April 2012. The key words were“bupivacaine, intra-articular, arthroscopic, postoperative pain, placebo”.
RESULTS AND CONCLUSION:Eighteen studies (n=934) were included (461 cases in bupivacaine group and 473
cases in the placebo control group). The Meta-analysis results showed the visual analog scale score of the bupivacaine group was lower than that of the placebo control group (weighted mean difference:-1.39, 95%confidence interval:-2.17 to-0.61, P<0.000 01), and the number of patients required supplementary analgesia was less than the placebo control group (relative risk:0.84, 95%confidence interval:0.62 to 1.66, P=0.010). The time from first supplementary analgesia to postoperative intra-articular injection in the bupivacaine group was longer that in the placebo control group (weighted
mean difference:157.72, 95%confidence interval:16.43 to 299.01, P<0.000 01). There was no significant difference in the incidence of side effect between two groups (relative risk:0.64, 95%confidence interval:0.29 to 1.44, P=0.48). On the basis of the currently available literature, the intra-articular of bupivacaine after arthroscopic surgery can significantly relieve pain without increasing the adverse reactions when compared with the placebo control group.

BACKGROUND:Ultrasonic therapy is one of several physical therapy modalities suggested for the management of pain and loss of function due to osteoarthritis. However, its effectiveness stil remains controversial in the previous studies.
OBJECTIVE:To analyze the effect of ultrasonic therapy for the treatment of relieving knee osteoarthritis pain.
METHODS:A retrieval of Pubmed, Ovid/Medline, Ovid/EMBASE, and Cochranee database was performed. The relevant literatures were manual y retrieved. The retrieval deadline was set on March 31, 2014. Randomized control ed trials on ultrasonic therapy of knee osteoarthritis were col ected.
RESULTS AND CONCLUSION:A total of eight studies of meta-analysis were accumulated. Among them, six studies adopted visual analog scale and Western Ontario and McMaster Universities Arthritis Index, one study adopted visual analog scale only, and one study adopted Western Ontario and McMaster Universities Arthritis Index. Then the Western Ontario and McMaster Universities Arthritis Index scores were transformed into visual analog scale scores for data analysis. There was a statistical difference between the groups in the visual analog scale pain score (standardized standard deviation:-0.51;95%confidence interval:-0.68,-0.33;P=0.05). Ultrasonic therapy is an effective method for knee osteoarthritis pain.

BACKGROUND:Reconstruction of the anterior cruciate ligament has become the gold-standard treatment for an anterior cruciate ligament rupture. Despite the popularity of the procedure, there remains a considerable amount of controversies over whether an autograft or anal ograft should be used for primary anterior cruciate ligament reconstruction. OBJECTIVE:To compare the clinical outcomes of al ograft and autograft in primary anterior cruciate ligament reconstruction. METHODS:Randomized control ed trials concerning autograft versus non-irradiated al ograft for anterior cruciate ligament reconstruction were identified from the PubMed/Medline database conducted up to July 12, 2014. These studies were selected independently by two reviewers according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman5.2 software. RESULTS AND CONCLUSION:A total of 6 randomized control ed trials consisting of 858 cases were included, 441 cases in autograft group and 417 cases in non-irradiated al ograft. The results of the meta-analysis indicate no significant difference between autografts and non-irradiated al ografts in overal IKDC [relative risk (RR)=1.02, 95%confidence interval (CI) (0.99 to 1.06), P=0.21], degree of laxity [mean difference (MD)=-0.13, 95%CI (-0.29 to-0.02), P=0.09], Lachman test [RR=1.04, 95%CI (0.95 to 1.13), P=0.37], pivot shift test [RR=1.00, 95%CI (0.95 to 1.05), P=0.96], one-leg hop test [RR=1.01, 95%CI (0.96 to 1.06), P=0.77], Lysholm score [MD=-0.64, 95%CI (-1.45 to 0.17), P=0.12], Tegner score [MD=0.16, 95%CI (-0.16 to 0.47), P=0.34] and rate of postoperative complications [RR=1.42, 95%CI (0.67 to 3.04), P=0.36]. Therefore, in the meta-analysis, there is no significant difference between autograft and non-irradiated al ograft in clinical outcomes. However due to the limitations of our study, further work is needed to determine this conclusion.

BACKGROUND:Symptomatic treatment is the main management strategy for patients with knee osteoarthritis at early metaphase. Some previous studies have demonstrated that neuromuscular electrical stimulation can al eviate pain in knee osteoarthritis patients. To date, this effectiveness, however, stil remains controversial.
OBJECTIVE:To assess the efficacy of neuromuscular electrical stimulation on pain in patients with knee osteoarthritis.
METHODRandomized control ed trials concerning the efficacy of neuromuscular electrical stimulation in the treatment of knee osteoarthritis were identified from the Medline database conducted up to July 3, 2014. These studies were selected independently by two reviewers according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman5.2 software.
RESULTS AND CONCLUSION:A total of 5 randomized control ed trials consisting of 239 participants were included. The results of the meta-analysis indicate neuromuscular electrical stimulation has no significant impact on measure of pain in knee osteoarthritis patients in comparison to the blank control group [mean difference=-0.40, 95%confidence interval (-1.34-0.54), P=0.40]. Owing to the sample limitations of our study, it is hard for us to draw a conclusion that the application of neuromuscular electrical stimulation in managing pain in patients with knee osteoarthritis is of little significance. Further work based on large-sample and high-quality randomized control ed trials is needed to determine the role of neuromuscular electrical stimulation in pain in this population.