目的观察A型肉毒毒素(BTX-A)治疗偏头痛注射位点、剂量对疗效的影响。方法对32例偏头痛患者采用固定点注射BTX-A治疗。结果治疗后,32例患者的头痛程度均明显减轻(P<0.01)。有5例患者出现颈后肌肉酸胀,3例出现轻度肌无力,无其他不良反应。结论BTX-A注射治疗偏头痛疗效明显,副作用少,维持时间长,操作简便。

Objective　To observe the effects and mechanism of TNFα and IL-1 on protein catabolism of skeletal muscles of mice in the early stage of severe burn. Methods　A BALB/c mice model was established with full thickness scalded of 18%～20% TBSA including the back and one hind limb. The catabolic rate of protein of soleus muscle was reflected with the net tyrosine releasing rate. The changes of the tyrosine releasing rates of the injured and uninjured limbs, the levels of TNFα and IL-1 of the plasma and soleus muscle, and the activities of lysosomal proteolytic enzymes were observed in 72 h after scald injury of the mice. Results　After injury, the levels of TNFα and IL-1 of plasma, injured and uninjured limbs were all increased, and reached the summit at the 48th h, but those of the injured limb were much higher than those of the uninjured one, then gradually the levels were decreased in 72 h. The protein catabolic rate of uninjured limb was higher than the normal at h 48, but it came to normal level at h 72. The rate of the injured limb was higher than that of normal and uninjured limbs significantly 72 h after the scalding. hrTNFα and hrIL-1 enhanced the protein catabolic rate and the activities of lysosomal protrolytic enzymes in the soleus muscle of normal mice in vivo and in vitro respectively. Conclusion　In the early stage of scald injury, TNFα and IL-1 could enhance the lysosomal protease activity, increase the protein catabolic rate in skeletal muscle and promote the negative nitrogen balance directly. These effects may not depend on the actions of emergent hormones.

Great progresses were made in the genetic study of osteoporosis during the past decade.Genetic variants of endocrine hormones,bone matrix proteins and cytokines involved in bone metabolism were closely associated with bone mineral density,bone quality,bone structure,bone turnover rate or osteoporotic fracture.This paper is a comprehensive review of the most important and representative molecular genetic study in osteoporosis,and the important problems in osteoporosis molecular study.

Objective To evaluate the influence of hyperthermia on T helper subgroup (T help type1/T help type2,Th1/Th2) for patients with esophageal carcinoma. Methods 22 patients of esophageal carcinoma were randomly divided into two groups. Both group patients were treated by external radiation, the total dose was 64-66 Gy/30-33 fractions. Radiotherapy was the only therapy method in group A. Hypertbermia was used twice every week, with 8-10 fractions except for radiotherapy in group B. All patients were phlebetomized at the beginning and the end of radiotherapy for examining Th1/Th2 by flow cytometry. Results Th1 was significantly decreased in group A(t = 5.33, P < 0.01). All indexes in group B had no difference (t = - 1.41, P > 0.05). TheThl in group A was decreased much more than that in group B(t = 4.28, P < 0.05). Conclusion Hyperthermia could rectify the balance of Th1/Tb2.

Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen.Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed.Results Preoperative imaging failed to define the tumors as nonhepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients.All the tumors were successfully resected,with combined hemigastectomy in 1 patient,partial resection of the lateral wall of the infrahepatic vena cava in 2,complete resection of adipose capsule of the right kidney in 2,pancreatoduodenectomy plus transverse colectomy in 1,and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1.The median operation time was 390 min (318-660 min).The median intraoperative blood loss was 2560 ml (400-6000 ml).The median intraoperative blood transfusion was 2450 ml (0 -5250 ml).The average diameter of the resected tumor was 14.5 cm (11-30 cm),and the average tumor weight was 2465 g (960-5100 g).Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a potentially malignant and undifferentiated tumor (solid pseudopapillary tumor of pancreas).Perioperative pancreatic anastomotic leak occurred in 1 patient,and there were no severe postoperative complications and operative death in this series.Tumor recurrence was detected 5 months following operation in 1 patient.The 1,2-,3-year survival rates were 100％,56％,33％,respectively.One patient survived for more than 5 years.Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms.The surgical resection rate was high.The prognosis for patients who received resectional treatment was satisfactory.

Objective To analyze the mutation characteristics of GBA gene in one patient with Gaucher disease and platelet transfusion refractoriness.Methods A female patient with anemia and thrombocytopenia showed platelet transfusion refractoriness,and then the proband and her family were performed bone marrow smear,β-glucocerebrosidase activity in leukocytes (dried blood spot assay),Bultrasonography and gene sequencing examination and pedigree investigation.Results Pedigree investigation showed that the heterozygous mutation of GBA gene existed in the father,mother,son,daughter and sister of the proband.Bone marrow cytomorphologic examination showed that Gaucher cells accounted for 6.0％ in the female patient.The β-glucocerebrosidase activity in leukocytes was 3.78 nmol/(h · mg Pro).B-ultrasonography showed slightly splenomegaly.Gene sequencing found that the homozygous mutation of GBA gene,c.484A ＞ G,existed in the female patient.Conclusion The patients with Gaucher disease may appear platelet transfusion refractoriness due to hypersplenism.The mutation of GBA gene is the main pathogenic factor of the family with Gaucher disease.

Objective　To observe the effects and mechanism of TNFα and IL-1 on protein catabolism of skeletal muscles of mice in the early stage of severe burn. Methods　A BALB/c mice model was established with full thickness scalded of 18%～20% TBSA including the back and one hind limb. The catabolic rate of protein of soleus muscle was reflected with the net tyrosine releasing rate. The changes of the tyrosine releasing rates of the injured and uninjured limbs, the levels of TNFα and IL-1 of the plasma and soleus muscle, and the activities of lysosomal proteolytic enzymes were observed in 72 h after scald injury of the mice. Results　After injury, the levels of TNFα and IL-1 of plasma, injured and uninjured limbs were all increased, and reached the summit at the 48th h, but those of the injured limb were much higher than those of the uninjured one, then gradually the levels were decreased in 72 h. The protein catabolic rate of uninjured limb was higher than the normal at h 48, but it came to normal level at h 72. The rate of the injured limb was higher than that of normal and uninjured limbs significantly 72 h after the scalding. hrTNFα and hrIL-1 enhanced the protein catabolic rate and the activities of lysosomal protrolytic enzymes in the soleus muscle of normal mice in vivo and in vitro respectively. Conclusion　In the early stage of scald injury, TNFα and IL-1 could enhance the lysosomal protease activity, increase the protein catabolic rate in skeletal muscle and promote the negative nitrogen balance directly. These effects may not depend on the actions of emergent hormones.

Objective To study the complications after laparoscopic bile duct exploration.MethodsTwo approaches for bile duct exploration were used in 105 patients: (1) laparoscopic transcystic common bile duct exploration (LTCBDE) was used for patients with gallstones with choledocholithiasis and cystic duct dilation. No T tube was used for drainage, (2) Laparoscopic common bile duct exploration (LCBDE) was used for patients with gallstones with choledocholithiasis but without cystic duct dilation. The common bile duct was sutured primarily without T tube drainage in those patients with a small number of stones. T tube drainage was used in those patients with many stones or severe edema at the lower end of the common bile duct. ResultsWe carried out LTCBDE+ LC in 70 patients and LCBDE+LC in 35 patients, 14 patients had T tube drainage and 21 patients had no T tubes in the latter group of patients. Postoperatively, there were ascites in 17 patients (LTCBDE 6 and LCBDE 11 ), biliary peritonitis in 5 patients (1 LTCBDE and 4 LCBDE), abdominal pain in 13 patients (LTCBDE 4 and LCBDE 9), and fever in 11 patients (LTCBD 3 and LCBDE 8). All the complications responded to conservative treatment. 14 patients in the LCBDE group had residual stones.Choledochoscopy was used to remove the residual stones.There was no pancreatitis. Conclusions Adequate preoperative workup, good clinical judgment and precise treatment skill help to reduce complication rates after operation for gallstones with choledocholithiasis.

0.05).The change of heart rate in 2 groups was greater than that of distilled water respectively(P

Objective To evaluate regional blood flow occlusion (RBFO) in hepatectomy for liver neoplasms. Methods In this study, hepatic tumors were resected under RBFO in 28 cases (RBFO group), and under Springle's technique (control group) in 24 cases. The Child-Pugh classifications of liver function were grade A in all patients. The ligature ribbon was put in liver parenchyma around tumor to block the blood supply before resecting the tumor under guiding of B sounography in RBFO group. Anesthesia time, blood loss and transfusion, hospitalization, change of liver function and complications were compared between the two groups. Results Blood loss, anesthesia time and postoperative hospital stay were (340±92) ml, (98.4±25.0) min, ( 10.2±2.3 ) d in RBFO group and (620±124) ml, ( 135.8±47.5 ) min, (16.5±5.1 ) d, respectively, in control group, differences were all significant between the two groups (P <0.01, t = 9.222,9.328 and 5.875, respectively). On post-op day 2, ALT (U/L) was (378.4±35.2) vs. (539.2±115.4) (t=7.012, P<0.01), TBIL (37.5±11.2) vs. (51.8±29) mmol/L(t=8.818, P<0.01),PT (17.4±2.4) vs. (20.4±2.8) see(t =4.16, P<0.01) in RBFO group and control group, respectively. ALT was (57.1±15.5) vs. (98.1±21.2) U/L(t =8.039),TBIL (25.4±4) vs. (46.3±13) mmol/L(t=8.085),PT (13.2±4.2) vs. (15.7±2.2) see (t=2.621)on post-op day 7 respectively, again the differences were all significant between the two groups (all P<0.01). Conclusion Regional blood flow occlusion is an effective technique to control blood loss during hepatectomy for liver neoplasms.