In order to explore the problems and countermeasure in the methodology of acupuncture and moxibustion clinical researches at present, clinical research literatures about acupuncture and moxibustion (Acup-Mox) published in recent years in our country were reviewed. For the urgent need of the current internationalization of Acup-Mox, the authors proposed the model of clinical research on Acup-Mox, which should strictly stick to the international standard and fully embody traditional Chinese medicine characteristics in the intervention measures of acupuncture. It is indicated that innovation of the methodology about clinical researches of Acup-Mox has great significance in improving the quality of clinical research on Acup-Mox in our country and promoting internationalization of Acup-Mox.
Acupuncture ; methods ; standards ; Biomedical Research ; methods ; standards ; Humans ; International Educational Exchange ; Medicine, Chinese Traditional ; methods ; standards ; trends ; Moxibustion ; methods ; standards ; Review Literature as Topic

Objective To investigate the relationship of HSP27 expression with treatment response ,remission rate ,prognosis in multiple myeloma(MM) patients .Methods Eighty‐six patients with MM first diagnosis and 27 relapse cases were collected re‐spectively .Control was defined as non‐hematological malignance .The MM patients divided into first diagnosis ,relapse conventional chemotherapy group and bortezomib group .HSP27 expression and protein level were measured on pre‐and post 1 ,2 and 3 treatment circles .Results The tendency of HSP expression and protein level:relapse‐MM patients> first‐diagnosis MM patients> control . HSP27 expression and level in Ⅲ phase was higher than those in Ⅱ phase for first‐diagnosis MM patients .Bortizomib‐containing chemotherapy protocol showed more effectively decrease on HSP27 than chemotherapy treatment only .At post‐1 treatment circle , HSP27<1 showed higher survival rate than HSP27>1 and delayed the relapse time .Conclusion BMMNC‐HSP27 expression and protein level is associated with staging ,treatment response and prognosis in MM patients .

BACKGROUNDThe vertebral artery (VA) and atlantoaxial joint (AAJ), with complicated structures, are located in the depths of the head-neck boundary area, the regional anatomy of which cannot be shown globally and directly. This study aims to evaluate three-dimensional CT angiography (3DCTA) in displaying the AAJ, atlantoaxial segment of the vertebral artery (ASVA) and the identification of their interrelations.

METHODSSixty-eight subjects without pathology of the ASVA and AAJ were selected from head-neck CTA examination. All the 3D images were formed with volume rendering (VR) together with techniques of separating, fusing, opacifying and false-coloring (SFOF). On the 3D images, the ASVA and AAJ were observed, and their interrelations were measured.

RESULTSAll the 3DCTA images were of high quality and up to our requirements. They could clearly and directly show the ASVA, ascending along the AAJ. There were 5 curves in the course of the ASVA, of which 2 curves were away from the atlantoaxial joint, one in the 2nd curve of 0.0 mm - 5.4 mm, the other in the 4th of 2.6 mm - 9.2 mm. There was no significant difference in the measurements between left and right (P > 0.05). The curved parts of the ASVA slightly expanded, with the biggest diameter of 5.6 mm in the 4th curve. Statistical comparison shows that the left ASVA is larger than the right (P < 0.05). Variations of the ASVA were found in 8 cases and of the AAJ in 12.

CONCLUSIONS3DCTA can globally and directly demonstrate the structures of the AAJ, ASVA and their interrelations. The 3D imaging data make up and enrich the research contents of regional anatomy and lay the foundation for related study and applications.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Atlanto-Axial Joint ; diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional ; methods ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods ; Vertebral Artery ; diagnostic imaging ; Young Adult

OBJECTIVETo study the characteristics histologic and cytologic features and clinical usefulness of plasma cell myeloma (PCM) subtyping according to WHO PCM classification.

METHODSBone marrow biopsy plastic-embedded sections were stained with H-G-E and Gomori's stains, and bone marrow aspirate smears were stained with Wright's stain. The clinicopathologic findings were then analyzed.

RESULTSOf the 131 cases with PCM, three types of growth patterns were noted: interstitial (21 cases, 16.0%), nodular (46 cases, 35.1%) and packed (64 cases, 48.9%). Besides, there were three cytologic subtypes: mature plasma cell type (43 cases, 32.8%), immature (81 cases, 61.8%) and pleomorphic (7 cases, 5.3%) types. The age of patients with mature plasma cell type was significantly higher than that of immature type (P = 0.005); and the number of tumour cells in bone marrow smears was significantly higher than that of immature type (P = 0.003). The numbers of WBC and platelets in peripheral blood were also significantly higher than that of pleomorphic type (P = 0.024, P = 0.002, respectively). On the other hand, the number of platelets in peripheral blood of immature type was significantly higher than that of pleomorphic type (P = 0.019). Marrow fibrosis was more frequently observed in immature type than in mature plasma cell type (P = 0.000). The incidence of marrow fibrosis and osteolytic lesions was higher in high risk group than in low risk group (P = 0.000, P = 0.023 respectively). Twenty-one cases (56.8%) of the 37 cases treated with MP or MP and M2 chemotherapeutic regimens showed good response. However, there was no significant difference in treatment response and survival between different subtypes.

CONCLUSIONSEach subtype of PCM carries different clinicopathologic features in some aspects. The classification carries important value in pathologic diagnosis and probably in predicting prognosis.

Adult ; Aged ; Aged, 80 and over ; Biopsy ; Bone Marrow Examination ; Female ; Humans ; Immunophenotyping ; Male ; Middle Aged ; Multiple Myeloma ; classification ; immunology ; pathology ; Prognosis

BACKGROUNDA growing volume of data suggests that simple manual thrombus aspiration followed by direct stenting improves myocardial reperfusion and clinical outcome compared with conventional primary PCI, but there is still limited data comparing the in vivo performance among different devices. This study aimed to compare the efficacy and operability of thrombus aspiration by the Diver CE (Invatec, Brescia, Italy) and ZEEK (Zeon Medical Inc., Tokyo, Japan) aspiration catheters in ST-segment elevation myocardial infarction (STEMI) and their impact on 3-month outcome.

METHODSFrom September 2004 to June 2008, 298 consecutive patients with STEMI who received manual thrombus aspiration were involved in a single center retrospective analysis. Of them, 229 and 69 were treated with Diver CE and ZEEK aspiration catheters, respectively. Primary endpoints were myocardial blush grade (MBG), thrombolysis in myocardial infarction (TIMI) flow grade, ST-segment elevation resolution (STR), device pushability and trackability as judged by the frequency of usage of dual guide wires and aspiration efficacy as indicated by size distribution of aspirated thrombi. Secondary endpoints were 3-month outcome including left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), as well as cardiac death, target lesion revascularization (TLR), re-infarction and their combination as major adverse cardiac events (MACE).

RESULTSBaseline characteristics were not different between the two groups expect for a higher frequency of temporary cardiac pacing in the ZEEK group (ZEEK) than in the Diver CE group (Diver CE) (0.44% vs 5.8%, P = 0.002). Visible retrieved thrombi were achieved in 65.9% of the Diver CE and 68.1% of the ZEEK (P = 0.74). Aspirated thrombi were categorized as small thrombi (< 3.5 mm), moderate thrombi (3.5-7.0 mm) and large thrombi (> 7.0 mm). Small thrombi were more frequently seen in the Diver CE (61.6% vs 42.6%), whereas moderate and larger thrombi were more frequently found in the ZEEK (38.4% vs 57.4%) (P = 0.021). Rates of dual wire utilization were 1.7% of the Diver CE and 7.2% of the ZEEK (P = 0.052). There were no differences in MBG, STR and TIMI flow grade between the two groups. No differences were found in cardiac death, TLR, re-infarction, MACE, LVEDD and LVEF between the Diver CE and the ZEEK during 3-month follow-up.

CONCLUSIONSBoth Diver CE and ZEEK manual aspiration catheters are effective for thrombectomy in STEMI. In clinical practice, ZEEK presents a stronger aspiration capacity for moderate to large thrombi compared with Diver CE, but Diver CE displays a trend towards better pushability and trackability than ZEEK. Differences in aspiration capacity and operability between Diver CE and ZEEK in this setting do not influence myocardial reperfusion and 3-month outcome.

Coronary Angiography ; Echocardiography ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; pathology ; surgery ; Thrombectomy ; instrumentation ; methods ; Treatment Outcome

OBJECTIVETo establish a rat model of scalding with controllable depth and area by high pressure steam.

METHODSHigh pressure steam apparatus consisting of an autoclave and a self-made scalding frame was employed in the study. The rats were inflicted with scalding with 0.12 Mpa (1 Mpa = 7500 mmHg) high pressure steam on the back through a hole of 2.6 cm in diameter for 3, 4, 5, 6, 7, 8, 9 and 10 seconds, with five wounds at each time point. The tissue samples were harvested at 24 post injury hour (PIH) for pathomorphological examination. The depth of scald was measured, and injury to the sweat gland and hair follicles injury, the hair growth in scalded area, and the wound healing condition were observed with Photoshop software.

RESULTSThere was positive correlation between the scalding depth and scalding time. The injury time for superficial and deep partial thickness burn and full thickness burn were 3, 5 and 7 seconds respectively. The wound healing time was similar even the scalding became more and more serious when injury time increased from 7 to 10 seconds.

CONCLUSIONThe scalding depth and area in this model could be controlled, and the degree of scald injury could be graded accurately with easy manipulation. The result showed that it was an ideal model of skin burn wound.

Animals ; Burns ; pathology ; Disease Models, Animal ; Male ; Pressure ; Rats ; Rats, Sprague-Dawley ; Steam

OBJECTIVETo seek ideal strategies in saving a patient with very extensive deep burns, and measures for functional reconstruction after convalescence.

METHODSA patient with 99. 5% TBSA flame burn injury (III degrees 80%, deep second degree 14.5% and superficial II degrees 5%), complicated with hypernatremia and hyperchloraemia was admitted 76 hours after the injury. Early escharectomy and alloskin grafting were performed. Because of the lack of autoskin donor site, the skin grafting of autologous skin was only undertaken whenever there was an available source, and the remaining wounds were temporarily covered with allografts. Finally the patient survived. After healing of all the wounds, contractures were corrected with skin from scars, flaps of scarred skin or composite skin, and more than 30 cicatricial contracture deformities were corrected after convalescence.

RESULTSAfter initial treatments and extensive early escharectomy, the patient's condition became stable gradually, without adverse complications. After 7 operations, the wounds finally healed completely after 106 days. The function of all joints were restored well and external appearance improved after 15 plastic and reconstructive operations during convalescence period. The patient was fully rehabilitated and resumed his original work 26 months after the injury.

CONCLUSIONFor those patients with massive burns and short of donor site, alloskin grafting after early escharectomy, and persistent repeated microskin grafting whenever any small amounts of own skin is available, is essential to stabilize the patients' condition, and reduce complications. Covering the wounds as the result of shedding off of eschar with alloskin can protect the undamaged cells in skin appendages to promote re-epithelization and wound healing. It is feasible to harvest skin grafts from scars, and use scar skin flaps and composite skin to repair contractures after convalescence with good outcome in function and external appearance.

Adult ; Burns ; surgery ; therapy ; Cicatrix ; surgery ; Contracture ; surgery ; Humans ; Male ; Reconstructive Surgical Procedures ; Skin Transplantation ; Surgical Flaps ; Wound Healing

BACKGROUNDWe developed a new combined strategy of thrombus aspiration plus intra-infarct-related artery (IRA) bolus administration of tirofiban via the aspiration catheter in patients with ST-segment elevation myocardial infarction (STEMI). This strategy can reduce the distal embolism and achieve highly localized concentrations of tirofiban, which can improve myocardial reperfusion without increasing the risk of bleeding. The aim of this study was to investigate whether this combined strategy is superior to thrombus aspiration alone in improving myocardial perfusion in patients with STEMI undergoing primary angioplasty.

METHODSThis single center study included 108 matched control patients with STEMI, angioplasty after thrombus aspiration, and 108 study patients with STEMI plus intra-IRA administration of 500 microg of tirofiban. Both groups had subsequent 12-hour intravenous infusion of 0.1 microg x kg(-1) x min(-1) of tirofiban after angioplasty. The primary end points were Thrombolysis in Myocardial Infarction (TIMI) flow immediately after angioplasty, ST-segment elevation resolution (STR) (> 70%) at 90 minutes after angioplasty, and the peak of creatine kinase-MB (CK-MB) and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at nine months follow-up, cardiac death, target vessel revascularization (TVR), re-infarction and the combination of these three as major adverse cardiac events (MACE) within nine months and any bleeding events.

RESULTSBaseline characteristics of the two groups were well-balanced. The TIMI 3 flow showed a better tendency in the intra-IRA group than in the aspiration alone group (97.22% vs. 87.04%, chi(2) = 7.863, P = 0.049). The peak of CK-MB (83.9 (68.9 - 310.5) U/L vs. 126.1 (74.7 - 356.7) U/L, P = 0.034) and TnI (42.7 (14.7 - 113.9) ng/ml vs. 72.5 (59.8 - 135.3) ng/ml, P = 0.029) were lower in the intra-IRA group than in the aspiration alone group. LVEF in the hospital favored the intra-IRA group, (45.7 +/- 8.3)% to (42.9 +/- 12.1)%, t = 1.98, P = 0.049. There was a tendency towards a lower MACE at 9-month follow-up in the intra-IRA group although it did not reach statistical difference (Log-rank chi(2) = 2.865, P = 0.09). There was no statistical difference in any bleeding events between the two groups.

CONCLUSIONSThrombus aspiration plus intra-IRA bolus administration of tirofiban combined with angioplasty may be related with improved myocardium perfusion, saved more myocardium, and resulted in a better clinical prognosis.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; methods ; Coronary Angiography ; Coronary Thrombosis ; drug therapy ; therapy ; Electrocardiography ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; therapy ; Platelet Aggregation Inhibitors ; therapeutic use ; Suction ; Treatment Outcome ; Tyrosine ; analogs & derivatives ; therapeutic use

Objective To determine whether early catheterization laboratory activation would reduce median door-to-balloon time in patients with ST elevation myocardial infarction (STEMI) . Methods Consecutive patients with STEMI underwent primary percutaneous coronary intervention (PCI) from January 2006 to December 2008 in Beijing Anzhen Hospital were analyzed. Patients were divided into three groups. Group A included patients without prehospital ECG (n = 168) , group B included patients with prehospital ECG (n = 224) and group C included patients with prehospital ECG and early telephonic notification to activate catheterization laboratory (n = 114). Primary end point was door-to-balloon time, secondary end points included peak Troponin I elevation, left ventricular ejection fraction, length of hospital stay, hospital mortality and 30 days follow-up mortality. Results Baseline characteristics were similar among groups. Door-to-balloon time and door-to-catheter laboratory time (110 minutes, 94 minutes and 85 minutes, respectively, all P <0. 01; 91 minutes, 74 minutes and 64 minutes, respectively, all P < 0. 01) were significantly shorter in group B and C than those in group A. The percentage of patients with door-to-balloon time less than 90 minutes increased significantly from 32% in group A to 43% in group B and 59% in group C ( P < 0. 01). Conclusion Early activation of catheterization laboratory by prehospital ECG and telephonic notification could markedly reduce door-to-balloon time in patients with STEMI.

Objective To investigate whether thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban via the aspiration catheter is superior to thrombus aspiration alone in improving myocardial perfusion in patients with ST-elevation myocardial infarction (STEMI) undergoing primary angioplasty. Methods In this single center retrospective study, 108 patients with STEMI who underwent angioplasty after thrombus aspiration plus intra-infarction related artery 500 μg tirofiban administration, with subsequent 12-hour intravenous infusion of 0. 1 pg · kg-1 · min-1 after angioplasty (thrombus aspiration + tirofiban group) and 108 matched control patients with STEMI who underwent angioplasty after thrombus aspiration (thrombus aspirartion group ). The primary end points included thrombolysis in myocardial infarction (T1MI) flow immediately after angioplasty, complete ST-segnent elevation resolution ( ＞70% ) at 90 minutes after angioplasty and the peak of creatine kinase-MB (CK-MB)and troponin I (TnI). The secondary end points were the left ventricular ejection fraction (LVEF) in the hospital and at 9 months follow-up as well as major adverse cardiac events ( MACE: cardiac death, target vessel revascularization, re-infarction ) at 9 months and any bleeding events. Results Baseline characteristics of the two groups were well-balanced. The TIMI 3 flow rate (97.22% vs. 87. 04%, P =0. 011 ) and the complete ST-segment resolution rate (66. 67% vs. 50. 91% ,&chi;2 =6. 129,P = 0. 047)were significantly higher in the thrombus aspiration + tirofiban group than in the thrombus aspiration group. The peak of CK-MB (83.9 U/L vs. 126. 1 U/L, P = 0. 034) and TnI (42. 7 ng/ml vs. 72.5 ng/ml, P =0. 029) were significantly lower in the thrombus aspiraton + tirofiban group than in the thrombus aspiration group. LVEF in the hospital favored thrombus aspiraton + tirofiban the group (45.7% + 10. 8%, 42. 9%±9.9%, t = 1.99, P =0. 049). There was a tendency to decreased MACE rate at 9-month follow-up,which favored thrombus aspiraton + tirofiban the group ( logrank &chi;2 = 2. 865, P = 0. 09). Bleeding events were similar between the two groups. Conclusion Thrombus aspiration plus intra-infarct-related artery bolus administration of tirofiban in patients with STEMI undergoing primary angioplasty may improve myocardium perfusion, attenuate myocardial ischemia and result in a better clinical prognosis compared to thrombus aspiration alone.