ObjectiveTo analyze the clinical features of tertiary hyperparathyroidism. MethodsThe data including symptoms, past history, bone and joint X-ray, bone mass density, bone SPECT, blood routine, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone ( PTH), as well as parathyroid ultrasonic or CT,parathyroid ECT, and parathyroid pathology were collected from seven patients with tertiary hyperparathyroidism.ResultsThe first symptom in 6 patients was bone ache, one of them was thirsty, and 1 patient had fracture. Four patients had past history of gallbladder stone or renal stone. Four subjects presented with osteoporosis and 2 of them had fractures. All 7 patients suffered from hypercalcaemia, along with high PTH level, 6 with hypophosphataemia and 6 with high alkaline phosphatase level. The enlarged parathyroid glands were detected in five patients by ultrasonic or CT. Tc99 scans of parathyroid gland revealed hyperfunctioning nodes in 3 subjects. Six patients were operated, and pathological results showed adenoma in parathyroid gland in 5 patients and adenocarcinoma in 1 patient. Serum calcium and PTH levels returned to normal in all the operated patients.ConclusionsPatients who present bone ache, osteoporosis, spontaneous fracture, past history of gallbladder stone or renal stone, high serum calcium, and PTH levels, should be aware of the probability of tertiary hyperparathyroidism. The confirmed diagnosis depends on pathological result.

Objective To evaluate clinical effects of integrated traditional Chinese and western medicine therapy for epilepsy after stroke. Methods Literatures about the treatment of epilepsy after stroke with the combination of traditional Chinese medicine and western medicine which come from the database such as CNKI, VIP, WanFang and Pubmed, were studied and all the randomized controlled trials on comparing therapeutic effects of treating epilepsy between combined treatment of TCM and western medicine and western medicine were enrolled. The Cochrane Collaboration's software RevMan 5 was used for meta-analysis. Results 7 articles were included in the study, there is homogeneity among these articles(P>0.05), The fixed effect model was used for the meta analysis. the combined results were OR=5.17, 95%CI(3.02, 8.82), the overall effect of test Z=6.01, P<0.01, the difference between the treatment group and the control groups was significant, that means the overall effect of the combination of traditional Chinese medicine and Western medicine treatment was better than western medicine treatment; Funnel plot graphic displayed asymmetrically, which indicated the literatures publication bias. Conclusion The current data indicate that the curative effect of TCM and west medicine combined treatment is better than pure western medicine therapy for epilepsy after stroke, but as the literature publication bias, clinical studies need more high quality large samples to prove this conclusion.

Objective To evaluate the application and risk of hematogenous tumor dissemination of intraoperative autologous blood salvage on radical nephrectomy for renal carcinoma with inferior vena cava tumor thrombus.Methods Between July 1999 and October 2005,19 patients with renal cell carcinoma invading inferior vena cava were used by the intraoperative autologous blood salvage.Preoperative and postoperative clinical data were analyzed and compared.The blood sparing effect and follow-up were evaluated.Results The intraoperative autologous blood salvage of all cases was successful.The levels of HCT,Hb and RBC on the 1st and 7th postoperative day were significantly lower than preoperative day.Although the level of PLT decreased on the 1st postoperative day,it recovered on the 7th day.The markers of liver and renal function did not change during treat time.Packed red blood cells were collected during surgery with a mean value of 1 765 ml(300～6 000 ml) per patient.The average amount of allogenic transfusion per patient was 2 247ml(0～8000 ml).The perioperative mortality rate was 10.5%(2/19).The postoperative metastasis rate was 35.3%(6/17).No difference was found in the prognosis between two groups.Conclusion The intraoperative autologous blood salvage does not markedly change the clinic test data and not increase the recurrence and metastasis of renal cell carcinoma.

Objective To observe the effects of Dengzhanhua Capsule on kidney tissue inflammatory cytokines in chronic renal failure rats;To explore its possible mechanism for the efficacy in chronic renal failure. Methods Sixty SD rats were randomly divided into normal control group, model group, benazepril group and Dengzhanhua group, 15 rats in each group. Chronic renal failure rat model was established by Platt 5/6 nephrectomized. Benazepril (0.29 mg/100 g) was given to rats in the benazepril group by gastrogavage. Dengzhanhua Capsule (0.3 g/100 g) was given to rats in the Dengzhanhua group by gastrogavage. Normal saline was given to rats in the normal group and the model group by gastrogavage. The whole treatment period was twelve weeks. Expressions of TGF-β1 and PAI-1 were determined by semi-quantitative RT-PCR after treatment. Concentrations of kidney tissue inflammatory cytokines IL-6 and TNF-α were determined by ELISA. Results Expressions of TGF-β, PAI-1 and IL-6, TNF-αin benazepril group and Dengzhanhua group were significantly lower than those in model group (P<0.05). Compared with benazepril group, it was significantly lower in Dengzhanhua group (P<0.05). Conclusion Dengzhanhua Capsule can reduce kidney tissue inflammatory in chronic renal failure rats, and inhibit renal fibrosis.

Objective To investigate the relationship between the evaluation of cerebral perfusion with CT perfusion (CTP)imaging and cognitive impairment in patients with asymptomatic severe internal carotid stenosis. Methods A total of 104 patients with asymptomatic severe unilateral internal carotid artery origin stenosis (the unilateral stenosis rate ≥70% and the contralateral stenosis rate < 30%)were enrolled respectively. After conducting Montreal Cognitive Assessment (MoCA)scores,they were divided into a non-cognitive impairment group (n = 24;MoCA ≥26)and a cognitive impairment group (n = 80;MoCA <26). All patients were performed digital subtraction angiography (DSA)and / or CT angiography (CTA)examinations. Their unilateral severe stenosis was confirmed,and they underwent brain CTP examinations. The relative cerebral blood flow (rCBF),relative cerebral blood volume (rCBV),relative mean transit time (rMTT),and relative time to peak (rTTP)were calculate by CTP. The presence rate of collateral circulation in 96 patients was calculated by DSA. The presence rate of collateral circulation,and relative perfusion parameters of the 2 groups were compared. Results (1)The MoCA score in patients of the non-cognitive impairment group was 27. 8 ± 1. 7,and the MoCA score in patients of the cognitive impairment group was 21. 4 ± 3. 1. There was significant difference between the 2 groups (t = 17. 959, P <0. 05). (2)The rate of 96 patients having collateral circulation was 68. 4% (52 / 76)in the cognitive impairment group,and in the non-cognitive impairment group was 60. 0% (12/ 20). There was no significant difference (P >0. 05). The CTP parameters rMTT,rTTP,rCBV,and rCBF in the non-cognitive impairment group were 1. 074 ± 0. 066,1. 103 ± 0. 032,1. 045 ± 0. 021 and 1. 066 ± 0. 040,respectively;the CTP parameters rMTT,rTTP,rCBV,and rCBF in the cognitive impairment group were 1. 241 ± 0. 169, 1. 328 ± 0. 248,1. 046 ± 0. 030,and 1. 093 ± 0. 058,respectively. The rTTP and rMTT of the cognitive impairment were longer than those of the non-cognitive impairment group. There were significant differences in rTTP and rMTT between the 2 groups (P < 0. 05),but there were no significant differences in rCBF and rCBV between the 2 groups (P >0.05). Conclusion Most of the patients with asymptomatic severe internal carotid stenosis has cognitive impairment,and cerebral perfusion caused by stenosis is significantly slower in patients with cognitive impairment than in those with noncognitive impairment.

Objective To investigate the clinical characteristics of cognitive impairment in the patients with asymptomatic unilateral severe internal carotid artery stenosis (ICAS). Methods A total of 80 patients with unilateral severe carotid stenosis (stenosis rate ≥70%)and 40 patients without carotid stenosis (control group)diagnosed by digital substract angiography (DSA)were analyzed retrospectively. According to the stenotic sides,the patients with severe ICAS were divided into a left stenosis group and a right stenosis group (n = 40 in each group). The North American Symptomatic Carotid Endarterectomy Trial (NASCET)criteria were used to grade the degree of stenosis. Montreal cognitive assessment (MoCA)was used to evaluate the cognitive function of the patients,and then the cognitive function of the patients in 3 groups was assessed. Results The MoCA total scores,visuospatial and executive functions,and language ability,and delayed memory scores of the patients in both left and right groups were lower than those of the control group. There were significant differences (21. 8 ± 3. 1,3. 4 ± 1. 3,1. 8 ± 0. 6,and 1. 6 ± 1. 3,respec-tively in the left stenosis group;22. 6 ± 2. 5,3. 5 ± 1. 1,1. 9 ± 0. 6,and 1. 7 ± 1. 4,respectively in the right stenosis group;and 26. 4 ± 1. 8,4. 2 ± 0. 9,2. 7 ± 0. 6,and 3. 8 ± 1. 0,respectively in the control group;all P < 0. 01). There were no significant differences in naming,attention,abstract ability,orientation ability scores compared with the control group (all P > 0. 05). There were no significant differences in the MoCA total scores and each single test score of the patients between the left stenosis and the right stenosis groups (P > 0. 05). Conclusion The patients with asymptomatic unilateral severe ICAS have cognitive impairment generally;it is characterized by delay memory,visuospatial and executive functions,and language dysfunction.

Objective To analyze the factors affecting the efficacy of postoperative radiotherapy (PORT) in node-positive non-small cell lung cancer (NSCLC). Methods 480 patients with stage N_1-N_2 NSCLC after radical surgery were retrospectively reviewed. Of them, 267 patients received adjuvant chemotherapy and 121 received PORT. All patients were grouped based on the N stage, tumor size and lymph node positive ratio (the percentage of positive lymph nodes from the detected lymph nodes, LNPR). Group 1 included patients with tumor size ≤3 cm and LNPR ≤33%, group 2 was tumor size > 3 cm or LNPR > 33%, and group 3 was tumor size > 3 cm and LNPR > 33%. The endpoints were the local recurrence free survival (LRFS) and overall survival (OS). Kaplan-Meier method and Cox's proportional hazards regression model were used for the statistic analyses. Results PORT improved the overall survival only in patients with N_2 disease. Both tumor size and LNPR significantly influenced the efficacy of PORT. The 5-year LRFS for patients with vs. without PORT in the group 1, 2 and 3 were 55% vs. 60% (χ~2 = 0.03,P-0.869), 42% vs. 50% (χ~2 =0.31,P=0.547),and 62% vs. 52% (χ~2=4.25,P=0.036), respectively;and the corresponding OS were 22% vs. 50% (χ~2 = 1.65 ,P =0. 199), 26% vs. 22% (χ~2= 0. 13,P=0.786) and 42% vs. 16% (χ~2= 15.33,P=0.000), respectively. Conclusions Tumor size and LNPR significantly impact the efficacy of PORT . For patients with stage N_2 NSCLC , PORT could improve local recurrence free survival and overall survival when tumor size > 3 cm and LNPR >33%.

Objective to investigate the feasibility and outcomes of different surgical treatments for adrenal metastasis after previous radical ne-phrectomy for patients with renal cell carcinoma. Methods A total of 18 adrenal solitary metastasis of renal cell carcinoma were identified from da-tabase of two institutions between 2003 and 2013. Clinical and pathologic data were collected and analyzed. Results Of 9 patients who had ipsilater-al metastasis of the renal tumor,the estimated blood loss were obviously fewer in the transperitoneal LA group. Of 9 cases who had contralateral me-tastasis of the renal tumor,the fasting time[(1.4±0.8)h vs(4.0±1.4)h,P = 0.036]and length of hospital stay[(4.5±1.2)d vs(7.0±4.5)d,P =0.041]were obviously fewer in the retroperitoneal LA group. the averages of the fasting time and length of hospital stay in the retroperitoneal LA group were obviously smaller than in the transperitoneal LA group. Conclusion LA for treatment of renal cell carcinoma metastasis is technically feasible in selected patients. transperitoneal and retroperitoneal LA can be respectively recommended as an appropriate approach for isolated adrenal metastases of ipsilateral and contralateral renal cell carcinoma after nephrectomy.

Objective To elucidate the clinical characteristics and coronary angiographic findings of patients underwent PCI before and after drug-eluting stents(DES).Methods DESIRE(Drug-Eluting Stent Impact on revascularization) was a retrospective registry of patients who received revascularization therapy during July,2001 through June,2002(non-DES era) and July,2003 through February,2004(DES era).In this analysis,we used the DISIRE data to examine the clinical and angiographic features of patients who received PCI in the different era.Results Among 3763 patients in the registry,2180 patients were analyzed(763 were in the non-DES era and 1417 were in the DES era).In the DES era,more diseased vessels(1.31?0.54 vs 1.39?0.61,P

Dental pulp stem cells(DPSCs) are adult stem cells with strong proliferative ability, self-renewal ability and multidirectional differentiation potential. DPSCs have abundant source are easy to obtain, and do not have ethical problems. As seed cells, they played an important role and showed great potential in tissue engineering and regenerative medicine, making them potential ideal seed cells for repairation and regeneration of tissue and organ. Clinical application of DPSCs in bone regeneration has already been achieved, and studies on differentiation of DPSCs into other tissues are still at different levels of basic stage. In this paper, the research and application of directional differentiation potential such as tooth formation, osteogenesis, and nerve formation are reviewed in order to provide clues and ideas for further study on DPSCs in the field of tissue engineering and regenerative medicine.