Objective Isosorbide-5-mononitrate(ISMN), a long-acting venous dilator,has been shown to decrease portal pressure and used in cirrhotic patients to prevent esophageal variceal bleeding(EVB). We performed a meta-analysis to evaluate ISMN in prevention of EVB. Methods Data from Medline(1968-2003), EMBASE(1986-2003), Cochrane Library(issue 3,2003),CJFD(1994-2003) were searched to retrieve randomized controlled trials comparing ISMN combined with or without other treatments to placebo or other treatments in prevention of EVB.Outcome measure was odds ratio( OR ) of bleeding rate. Mantel-Haeszel method was used in fixed model, while Der Simonian and Laird methods were used in random model. Results Seven trials were identified including prevention of first bleeding and rebleeding. The results of meta-analysis indicated that ISMN had no effect on prevention of EVB[study group vs control group: 88/463 vs 117/465, random model: OR (95% CI ): 0.63(0.37, 1.08 )]. Based on sensitivity analysis compared with control group, ISMN had no effect [43/314 vs 40/314, fixed model: OR :0.63(0.37, 1.08)]on prevention of first bleeding, but had therapeutic efficacy [45/149 vs 77/151, fixed model: OR :0.39 (0.24,0.65)]on prevention of rebleeding. Combination therapy of ISMN and ?-blocker revealed more effective than single therapy with ?-blocker[53/327 vs 74/329, fixed model: OR :0.64(0.42, 0.98)]in prevention of rebleeding [25/80 vs 41/81, fixed model: OR :0.44(0.23, 0.85 )], but had no significant difference in prevention of first bleeding[28/247 vs 33/248, fixed model: 0.84(0.48, 1.44)]. Conclusions ISMN is effective in prevention of esophageal variceal rebleeding. Furthermore , combination with ?-blockers has more therapeutic efficacy in prevention of esophageal variceal rebleeding.

BACKGROUND: There are many treatment approaches of the cervical spinal cord injury but the results were all unpleased.OBJECTIVE: To discuss the effect of the operation and other colligate treatments on the functional recovery of the patients who suffered from the cervical central spinal cord injury.DESIGN: A preoperative and postoperative control study.SETTING: Orthopaedic department in an affiliated hospital of a university.PARTICIPANTS: Eleven male patients of the central spinal cord injury,whose ages ranged from 36 to 65, were chosen from the Orthopedic Department of People' s Hospital of Jiangsu Province from January 1999 to January 2003. Nine cases suffered from traffic accidents. One case suffered from falling injury. One case suffered from head smash injury. The courses of diseases were from 2 hours to 14 days. Nine cases were accompanied with the cervical intervertebral disc herniation. One case was accompanied with the cervical vertebral canal stenosis. One case was accompanied with the fracture of the C6 vertebral body. Nine cases showed single segment injury and 2 cases showed two segment injuries in the MRI plate.METHODS: The operation was done 4 to 20 days after the injury. Anterior cervical intervertebral disc removal, bone implantation and the internal fixation of the armor plate were done in 9 cases. Posterior route cervical vertebral depression, bone implantation and internal fixation of the lateral armor plate were done in 2 cases.tion.RESULTS: Before the operation 11 cases were classified according to the Frankel Grade: 3 cases of 0 grade, 3 cases of Ⅰ grade and 5 cases of Ⅱ grade. After the operation 1 case of 0 grade, 4 cases of Ⅲ grade, and 6 cases of Ⅳ grade. The mean muscular power recovered 2 to 5 grades. The re-examination of the internal fixation was firm and right-located. The implanted bone healed well.CONCLUSION: After the diagnosis of the cervical central spinal cord injury, the colligate treatment is suggested. The operation removes the pathogenic factors as soon as possible, and other assistant treatments promote the functional recovery of the spinal cord.

Objective To determine the risk factors of light perception and no light perception appearenee after vitrectomy for pro-liferative diabetic retinopathy (PDR). Design Retrospective, noncomparative case series. Participants 242 patients (288 eyes) who un-derwent vitrectomy for PDR. Methods 288 eyes of participants from 2002 to 2006 at Beijing Tongren Eye Center were reviewed. Cases that had postoperative visual acuity of light perception (LP) and no light perception (NLP) were recorded and PDR stages, traction reti-nal detachment involving macula, postoperative retinal detachment, postoperative vitreous hemorrhage, postoperative neovascular glauco-ma and re-operations were analyzed. Main Outcome Measures Postoperative complications, PDR stage, macular disorder. Results Subjects were divided into two groups. LP/NLP group included eyes that had postoperative visual acuity of light perception and no light perception (totally 14 eyes in this group). Another group (control group) included eyes that had postoperative visual acuity of hand mo-tion or better (totally 274 eyes in this group). When compared with control group, the LP/NLP group had significantly higher prevalence of PDR 6, traction retinal detachment involving macula, postoperative retinal detachment, postoperative vitreous hemorrhage, postopera-tive neovascular glaucoma and reoperation (P value was 0.042, 0.048, 0.048, 0.000, 0.000, 0.000, respectively). Conclusion Risk factors of light perception and no light perception after vitrectomy for PDR include PDR stage 6, traction retinal detachment involving macula, postoperative retinal detachment, postoperative, vitreous hemorrhage, postoperative neovascular glaucoma and re-operation. (Ophthalmol CHN, 2009, 18: 251-253)

Objective To investigate the relationship of expression of cyclooxygenase-2(COX-2) and vascular endothelial growth factor(VEGF) with the growth pattern,malignant degree,metastasis and prognosis of gastrointestinal stromal tumor(GIST).Methods The expression of COX-2 and VEGF was examined with immunohistochemistry from paraffin-embedded tissue sections of 54 patients with GIST,and special attention was given to analyze the relationship between COX-2、VEGF expressions and clinicopathologic factors of the neoplasm.Results The expression of COX-2 and VEGF was significantly higher in malignant GIST than in benign and potentially malignant GIST(P

Objective:To investigate the clinical application value of nano-carbon tracer technology in lymph node dissection and postoperative pathological examination in laparoscopic mid-low rectal cancer resection.Methods:Fifty-two patients with mid-low rectal cancer were randomly divided into experimental group (n=27) and control group (n=25).Before surgery,the Nano-group were injected nano activated carbon suspension liquid under the mucosa.Both groups were accepted the same principles of open colorectal cancer radical surgery.The total number of lymph nodes,number of tiny lymph nodes,number of black dye and number of metastasis lymph node confirmed by pathology in the two groups were statistical analysised.Results:There were 905 pieces of lymph node seized in two groups toally,including (20.67 ± 5.751) medals in Nano-carbon group and (13.88 ±4.466) medals in control group.Lymph node number in nano carbon group was more than control group (P＜0.01).Nano-carbon group seized 113 tiny lymph nodes,significantly higher than 49 in the control group (P＜0.05).The metastasis rate of lymph node was no significant difference in the two groups (P＞0.05).Nano-carbon group seized lymph node metastasis was no significant difference in the rate of the control group (P＞0.05).Nano-carbon group seized 341 black dyed lymph nodes and 217 not black dye lymph nodes.And 67 cases of metastasis lymph nodes in Black dye lymph nodes,15 cases of metastasis lymph nodes in not the black dye lymph nodes.The metastasis rate of black dye lymph node was higher(P＜0.01).Conclusions:Nano-carbon tracer technique can guide the surgeon to accurately lymph nodes dissection during the operation,and can add to the number of lymph nodes in the postoperative surgical specimens,improve lymph nodes in patients with colorectal cancer radical seized quantity.Nano-carbon tracer technique can ensure the accuracy of the pathological staging,there was important clinical significance to lymph node dissection in Mid-low colorectal cancer,which provide an important basis for the development of postoperative adjuvant therapy programs.

To develop an inquiry scale for diagnosis of heart system syndromes, and to discuss the provisional standardization of the inquiry method in traditional Chinese medicine (TCM).

Objective:To evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) for adult severe tetanus by comparing the NLR in patients with severe and mild tetanus.Methods:A total of 65 adult tetanus patients from the Linyi Central Hospital from January 2009 to December 2020 were enrolled. The patients were divided into two groups including mild group and severe group according to the Ablett classification. The general conditions, laboratory data, and NLR of patients in two group were retrospectively compared using independent samples t test. Multivariate logistic regression analysis was used for the analysis of risk factors for severe tetanus. Spearman correlation method was used for the analysis of the correlation between risk factors and Ablett grades. Receiver operator characteristic (ROC) curve was used for the evaluation of the predictive value. Results:Among the 65 tetanus cases, 34 was in mild group and 31 in severe group. The latency period of patients in severe group was (7.00±3.19) d, which was shorter than that in mild group ((9.18±2.59) d), and the difference was statistically significant ( t=3.03, P=0.004). The NLR of patients in severe group was 4.251±1.936, which was higher than that of mild group (2.533±1.026) , and the difference was statistically significant ( t=4.41, P<0.001). Multivariate logistic regression analysis showed that NLR and latency period were independent risk factors for tetanus severity (odds ratio ( OR)=2.359, 95% confidence interval ( CI) 1.415 to 3.934, P=0.001 and OR=0.748, 95% CI 0.599 to 0.936, P=0.011, respectively). In tetanus patients, the NLR level was positively correlated with Ablett grade ( r=0.644, P<0.001). The ROC curve showed that NLR had good predictive value for adult severe tetanus at a cut-off value of 2.471 (area under the curve (AUC)=0.787), with the sensitivity and specificity of 87.1% and 61.8%, respectively. When combining NLR with latency period (cut-off value of 7.5 d), predictive efficiency was further improved (AUC=0.832) with the sensitivity of 87.1% and specificity of 67.6%( Z=3.43, P<0.001). Conclusions:NLR has a good predictive value for adult severe tetanus, and the predictive efficiency is further improved when combined with latency period.

Objective To study the clinical, laboratorial, histopathological, imaging features of two cases of hypothyroid myopathy. Method Clinical manifestations, thyroid function, electromyography, muscle MRI, muscle biopsy and follow-up results were collected, and analyzed with the literature. Result These two patients were middle-age to old age and the onset of disease was insidious. Their common clinical manifestations included subacute progressive weakness in the proximal muscles,myalgia after sports and reduction in tendon reflex.The blood test showed an increase in serum concentration of CK and TSH, and a decrease in FT3 and FT4. The electromyography showed suspicious myogenic damage.Muscle histopathological findings were largely nonspecific,such as type I fiber predominance and type 2 atrophy. The MRI revealed extensive muscular dystrophy and fatty filtration in the posterior group of thighs. Treatment of replacement therapy with L-T4 relieved the myopathic symptoms quickly. Conclusion When a patient presents with a subacute progressive weakness in the proximal muscles, the hypothyroidism should be consideration. Muscle histopathological findings may be nonspecific. The muscle MRI have a value of differential diagnosis and lesion assessment.

Objective To analyze the risk factors of cerebral microbleeds (CMBs) in acute cerebral infarction patients. Methods We consecutively included 255 acute cerebral infarction patients who were admitted in Neurology Department of the First Affiliated Hospital of Fujian Medical University from January 2014 to December 2016. According to the number and location of CMBs, the patients were divided into infratentorial, cortical and deep cerebral groups, each of which included non-mild and moderate-severe subgroups. The differences of the level of glomerular filtration rate (eGFR) and some common arteriosclerotic risk factors were analyzed between subgroups, and the multiple logistic regression analysis was performed. Results A total of 140 subjects (54.9%) had CMBs. In the infratentorial group, the proportion of patients who were with low eGFR level in the moderate-severe CMBs subgroup was higher than in the non-mild CMBs subgroup (P=0.024). The low eGFR level (OR=3.874, 95% CI:1.261～11.901, P=0.018) and the long duration of hypertension (OR=2.128, 95%CI: 1.004～4.510, P=0.018) were the independent risk factors of the moderate-severe infratentorial CMBs. Conclusion The low eGFR level and long duration of hypertension are risk factors for the moderate and severe infratentorial CMBs after acute ischemic stroke.