Acupuncture Therapy ; instrumentation ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Dyspnea ; therapy ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Young Adult

Objective:To evaluate the preventive effect of Danshen Shuizi Capsule on vascular restenosis after stent implantation.Methods:48 patients with endovascular stent implantation were randomly assigned to control group(n=25) (treated with western medicines)and treatment group(n=23)(treated with Danshen Shuizi Capsule)after endovascular stenting implantation.The intraluminal diameter of stenting segment was measured by QCA at 6 months after stent implantation.Results: The diameter of reference vessel in two groups was not significantly different.The intraluminal diameter of stent segment in the treatment group was not larger than that in the control group(2.22?0.21)mm vs(2.18?0.25)mm.The index number of vessel diameter reduction in treatment group was not less than that in the control group(0.50?0.16)mm vs(0.51?0.11)mm.The rate of restenosis(18.4%)and reintervention(13.1%)in treatment group were not lower than those in the control(20%,12%).However,the complication in treatment group was significantly lower than that in control group.Conclusion:These findings indicated that endovascular was useful for the prevention of endovascular restenosis after stent implantation with fewer complications

BACKGROUND: Enophthalmos deformity is the most common complication caused by orbital blow-out fractures, and others are diplopia and worsening of visual acuity. Since the therapeutic result of orbital blow-out is not satisfactory and many complications exist after operation, it is still a dispute to select implantation materials and therapeutic regimens.OBJECTIVE: To observe the therapeutic effect and assess the improvement of visual function by surgical reconstruction with porous high-density polyethylene (Medpor) for the correction of enophthalmos deformity caused by orbital blow-out fractures.DESIGN: A pre-and postoperative controlled study.SETTING: Beauty Center for Trauma Repair,Plastic Surgery Hospital,Peking Union Medical College, Chinese Academy of Medical Science .PARTICIPANTS: Totally 56 patients with orbital blow-out fractures who had enophthalmos deformity caused by fists or traffic accidents, treated at Beauty Center for Trauma Repair,Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, were selected in this study from December 1996 to March 2004. Final diagnosis were made with case history, X-ray film, two-demensional and three-dimensional CT before operation. 24 cases were accompanied with other areas fractures such as zygoma and nasal bone, 34 cases with diplopia, 35 cases with visual acuity worsening after injured.METHODS: ①Material implantation: Exposure of the orbital floor, inferior and medial walls could be performed through a 2 mm inferior subciliary incision of 3 cm long. To approach the orbital rim via a dissection plane anterior to the orbital septum, sub-periosteal dissection was then performed over the orbital rim, and along the orbital floor to the orbital apex. Mobilized the soft tissue from the bone throughout the entire area of fractures and re-position it to its proper position. Took Medpor (Type 6331) sheets as the implantation materials, trimmed Medpor sheets according to the radian and anatomic form, and 2 mm larger than the defect rim was needed.If other operations were needed during the operation, they could be done.Mannitol and dexamethasone should be used just postoperatively to decrease edema of the orbital contents and reduce inner orbital excessive pressure. ②Functional evaluation standard: Diplopia: completely disappear meant recovered, less diplopia residual meant improvement, no improvement meant inefficacy. Enophthalmos: marked improvement meant the degree of enophthalmos stabilizated at below 2 mm, less improvement meant stabilizated at above 2 mm.MAIN OUTCOME MEASURES: ①Improvement of enophthalmos; ②Improvement of diplopia ; ③Improvement of visual acuity.RESULTS: ①All 56 cases of enophthalmos deformities caused by orbital blow-out fractures improved greatly. ② Of all the 34 patients with diplopia, 27 recovered. ③ 9 patients' visual acuity of 35 improved with different degrees. No diplopia or visual acuity worsening occurred. With a follow-up ranging from 2 months to 5 years, the degree of enophthalmos stabilizated at below 2 mm, and no relapse and other complications occurred.CONCLUTION: Medpor has such advantages as better histocompatibility,fewer complications and better visual function improvement, so it is the preferred implantation material for correcting enophthalmos deformity caused by orbital blow-out fractures.

Objective To explore the appropriate pneumoperitoneum pressure in different surface area children during pediatric laparoscopic surgery,so as to attenuate the intederence with physiological function and avoid pneumoperitoneum correlative complications.Methods 120 patients underwent laparoscopic surgery were divided into three groups by different surface area:A(0.43～0.67m2),B(0.68～0.92m2),C(0.93～1.17m2).Each group was divided into two subgroups again by different pneumoperitoneum pressure:A1(4 mm Hg),A2(6mm Hg),B1(7mm Hg),B2(9mm Hg),C1(10mm Hg),C2(12 mm Hg).The cardiorespiratory function and blood gas analysis in different time point before and after pneumoperitoneum were monitored.Results The increase of PET CO2,Paw,HR,MAP and PaCO2 in A2,B2,C2 were more obvious than in A1,B1,C1(P ＜ 0.01).The eligible pneumoperitoneum pressure for A,B,C were 4,7,10mmHg respectively.The complications of gastric contents back-streaming and respiratory acidosis were 7 cases in A2,B2,C2 in all,and 3 cases in A1,B1,C1.Conclusion Using a compatible pneumoperitoneum pressure for different surface area children could attenuate the interference of physiological function and avoid pneumoperitoneum correlative complications.

Objective To retrospectively summarize the normal reference range of trachea wall thickness,lumen diameter,wall area and wall area ratio[WA%=mean wall area/(mean wall area+lumen area)]of Chinese healthy adults,and its related factors. Also,to observe the difference of inner diameter between superior and inferior bronchus.Methods Based on computer measurement techniques of bronchus,a CT quantitative analysis was carried out in 701 cases of normal healthy people who had negative results in lung cancer screening of health examination at our hospital.Results The value of trachea wall thickness,lumen diameter,wall area and wall area ratio was(1.322 mm,18.024 mm,78.93 mm2 ,0.27)respectively.In different gender,the trachea wall thickness,lumen diameter,wall area and wall area ratio had statistical significance (P<0.05).Also,they had good consistency with gender (r=-0.512,-0.472,-0.559,0.315).In different gender and age,the difference of inner diameter between the superior bronchus and inferior bronchus was always a positive value.Conclusion The CT quantitative analysis method has advantages of convenience,direct-vie-wing and accuracy.It is good for quantitative detection and research of bronchus structure.Bronchial wall thickness,lumen diameter, wall area and wall area ratio have significant difference because of gender.The inner diameter of superior bronchus is always greater than that of the inferior bronchus.

ObjectiveTo investigate the clinical effect of endoscopic sphincterotomy with balloon dilation (ESBD) versus sphincterotomy (EST) alone in the treatment of large common bile duct stones. Methods Foreign databases (including PubMed, CochraneCentral, and Embase) and Chinese databases (including CNKI and Wanfang Data) were searched for randomized controlled trials (RCTs) on the clinical effect of ESBD versus EST in the treatment of large common bile duct stones published up to July 8, 2019. Related data were extracted and RevMan5.3 was used for analysis. Results A total of 13 RCTs with 1926 patients were included, with 973 patients in the ESBD group and 953 patients in the EST group. The meta-analysis showed that there were significant differences between the ESBD group and the EST group in stone clearance rate (odds ratio ［OR］=1.53, 95% confidence interval ［CI］: 1.03-2.29, P=0.04), one-time clearance rate (OR=1.77, 95%CI: 1.06-2.93, P=0.03), rate of use of mechanical lithotripsy (OR=0.40, 95%CI: 0.25-0.63, P＜0.000 1), bleeding rate (OR=0.23, 95%CI: 0.11-0.50, P＜0.001), incidence rate of cholangitis (OR=0.31, 95%CI: 0.12-0.78, P=0.01), incidence rate of early complications (OR=0.59, 95%CI: 0.42-0.84, P=0.003), and time of operation (mean difference=-8.89, 95%CI: -17.56 to -0.22, P=0.04), while there were no significant differences between the two groups in perforation (OR=0.27, 95%CI: 0.05-1.30, P=0.10) and pancreatitis after endoscopy (OR=1.03, 95% CI: 0.66-1.61, P=0.91). ConclusionIn endoscopic treatment of large common bile duct stones, ESBD has several advantages over EST in stone clearance rate, rate of use of mechanical lithotripsy, bleeding rate, incidence rate of cholangitis, and time of operation.

Objective To investigate the changes of myosin heavy chain ( MyHC) isoforms in rat masseter muscle fibers caused by chronic sleep deprivation ( CSD) and a possible link with the pathogenesis of temporomandibular joint disorders ( TMD ) .Methods Total 180 male rats were randomly divided into three groups( n=60 per group): chronic sleep deprivation group ( CSD),cage control group ( CC),and large-platform control group ( TC ) .Each group was further divided into three subgroups ( n=20 in each group)according to the observation time point(7,14,and 21 days).The expression of MyHC isoforms in mas-seter muscle fibers was investigated by real-time quantitative PCR,Western blotting and immunohistochemi-cal staining.Results The expression of MyHC-Ⅰ,MyHC-ⅡA and MyHC-ⅡB deep and shallow masseter muscle in CSD7d group had differention with the control group(MyHC-Ⅰ:(0.314±0.005,0.134±0.005, P<0.05;MyHC-ⅡA (7.960±0.465,7.090±0.564, P<0.05;MyHC-ⅡB:(2.840±0.054,2.580±0.054, P<0.05) .The expression of MyHC-Ⅰdeep and shallow masseter muscle in CSD 14 d group had differention with the control group(0.284±0.005,0.106±0.015, P<0.05),the same appearance as MyHC-ⅡA deep and shallow masseter muscle(7.030±1.045,6.050±0.976, P<0.05) and MyHC-ⅡB deep and shallow masseter muscle((3.680±0.548,3.850±0.457, P<0.05).CSD groups exhibited increased MyHC-Ⅰexpression in both the deep and shallow muscle fiber layers at 7 days compared with CC and TC groups(P<0.05) ,whereas CSD significantly decreased MyHC-ⅡA and MyHC-ⅡB expression(P<0.05) .The expression of MyHC-Ⅱwas sig-nificantly decreased in CSD 7 d group,while the expression of MyHC-Ⅰwas increased.As the CSD time ex-tended,the MyHC-Ⅱexpression was increased and MyHC-Ⅰexpression was descreased.CSD 21d group ex-hibited significant different from MyHC-Ⅱand MyHC-Ⅰexpression in the deep muscle fiber layer compared with those in CC and TC groups (P<0.05) ,while there was no difference of MyHC-Ⅰor MyHC-Ⅱexpression in the shallow muscle fiber layer between CSD group and CC group (P>0.05) ,and there were no differences between the CC and TC groups at any time point.Conclusion These findings suggest that CSD alters the ex-pression of MyHC isoforms,which may contribute to TMD pathogenesis.

Objective: To observe the effect of ivabradine (IVA) on atrial and ventricular monophasic action potential duration (MAPD) and its proarrhythmic action at presence of sea anemone toxin-II (ATX-II) in isolated rabbit heart modelin vitro. Methods: The perfusion of isolated heart from female New Zealand white rabbit was conducted by Langendorff method in vitro. Left atrial and left ventricular endo- , epi-cardial action potential were recorded when pacing with ifxed frequency of 350 ms (in correspondence with the heart rate of 171 times/min) to observe the effect of IVA alone and ATX-II (3 nmol/L) with IVA on MAPD90. In addition, to observe the action of IVA alone and ATX-II with IVA on proarrhythmia when IVA reducing the heart rate to autonomous cardiac rhythm as (156±10) times/min. Results: IVA at (3-10) μmol/L prolonged atrial and ventricular endo- , epi-cardial MAPD90 by (15.9 ± 2.0) ms, (31.5 ± 4.0) ms and (23.9 ± 3.0) ms (n=6,P<0.01), respectively. ATX-II at 3 nmol/L prolonged atrial and ventricular MAPD90 by (36.5 ± 5.0)ms and (19.9 ± 3.0) ms, (19.5 ± 4.0) ms (n=6,P<0.01) respectively. With ATX-II treatment, IVA at (6-10) μmol/L decreased atrial MAPD90 by (14.4 ± 4.0) ms (n=6,P<0.01), it induced atrial arrhythmia. With 3 nmol/L of ATX-II treated ventricle, IVA at (3-10) μmol/L obviously prolonged endo- and epi-cardial MAPD90 by (36.2 ± 7.0) ms and (27.5 ± 5.0) ms(n=6,P<0.01), respectively. IVA didn’t increase ventricular beat-to-beat variability and transmural dispersion of MAPD90 no matter with or without ATX-II treatment, no ventricular arrhythmia occurred. Conclusion: IVA prolongs both atrial and ventricular MAPD, with increased late sodium current, IVA may induce atrial arrhythmia but not ventricular arrhythmia in experimental rabbits in vitro.

OBJECTIVETo analyze the clinical characteristics of pediatric neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD).

METHODA retrospective analysis was performed evaluating clinical and laboratory characteristics of ten NMO and NMOSD children who were seen in our hospital from December 2010 to May 2014. Median age at onset was 8.9 years (range 0.8-13.8 years). Seven cases were female and three were male. Median disease duration was 1.5 months (range 1-18.5 months).

RESULTEight patients fulfilled diagnostic criteria for NMO and two patients fulfilled diagnostic criteria for NMOSD. The two NMOSD patients had recurrent longitudinally extensive transverse myelitis. Four cases had a monophasic disease course, and six cases had a recurrent course. In eight NMO patients, neuritis was the initial presentation. The two NMOSD patients had no neuritis in the first attack. Nine cases had clinical manifestations of myelitis, one case had asymptomatic spinal cord MRI anomaly. Among the ten patients, seven cases had brain lesions, wherein, four cases had the midbrain involvement and in four cases extensive hemispheric white matter was involved. Three cases had medullary involvement. And two cases had posterior limb of the internal capsule involvement, two cases had thalamus involvement. In one case there was pons, cerebellum or corpus callosum involvement, respectively. One case had accompanied brain symptoms. Of the five patients who had symptomatic brain lesions, four cases had encephalopathy accompanied by large hemispheric lesions on MRI, having a presentation similar to acute disseminated encephalomyelitis. And one case had multiple sclerosis like brain lesion. Of the ten patients tested, nine were seropositive for anti-aquaporin-4 autoantibody. One-patient was complicated with systemic lupus erythematosus. Oligoclonal bands were negative in all cases. All patients received treatment for acute attacks with high-dose intravenous methylprednisolone and intravenous gammaglobulin. The symptoms of 8 cases mitigated. Two cases whose symptoms showed no sign of improvement received plasmapheresis for acute attacks. Seven of the patients were followed up. The median duration of follow-up was 19 months (ranged from 13 months to 30 months). The median Expanded disability status (EDSS) score was 3 (range 1-7).

CONCLUSIONPediatric NMO and(or) NMOSD have a diverse clinical presentation which are more than just optic neuritis and transverse myelitis, including brain symptom. So it may be difficult to distinguish NMO and( or) NMOSD from acute disseminating encephalomyelitis and multiple sclerosis in the early stages of the disease. Antibodies to aquapoin-4 (AQP-Ab) testing is very important for differential diagnosis.

Adolescent ; Anti-Inflammatory Agents ; therapeutic use ; Aquaporin 4 ; Autoantibodies ; Brain ; Brain Diseases ; Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Methylprednisolone ; therapeutic use ; Multiple Sclerosis ; etiology ; Neuromyelitis Optica ; complications ; diagnosis ; drug therapy ; Retrospective Studies

Objective To evaluate the dynamic contrast-enhanced MRI (DCE-MRI)in detecting experimentally induced testicular ischemia. Methods Thirty healthy male New Zealand rabbits were randomly assigned into 6 groups. There were 5 rabbits in each of the following experimental groups: ( 1 ) Normal control, (2) Sham-operated, (3) ischemia of 3 h group, (4) ischemia of 6 h group, (5) ischemia of 12 h group, (6) ischemia of 24 h group. In all experiment groups, the right testis served as the internal control while the left testis served as the experimental side. DCE-MRI for each animal lasts about 10 minutes. Signal enhanced ratios (SERs) of ROI for both sides of each group were calculated by a computer, and parameters of SERs of 30 s, 75 s, 120 s and maximal SER were used for statistical analysis.Time intensity curves (TICs) were made for two sides of each group via Excel 2003 software and classified into 4 types. Statistical analysis was performed to compare the differences of SERs between left and right testis by two independent Kolmogorov-Smirnov test. Results In group I and 2, significant enhancement was observed on both testes of 10 rabbits. The enhancement decreased gradually with the elongation of ischemia in torsion groups. Three cases of type Ⅰ and 2 cases of type Ⅱ were observed in group 1,5 cases of type Ⅰ in group two, 2 cases of type Ⅰ and 3 cases of type Ⅱ b in group three, 2 cases of type Ⅰ and 2 cases of type Ⅱ b in group four, 5 cases of type Ⅱ b in group five and 5 cases of type Ⅲ in group six were noticed in the left testes. And in TICs of right testes, all cases showed TICs of type Ⅰ except 2 cases of type Ⅱ a in group six. In four torsion groups, the values for SER75 of the left side were 0. 084%, 0. 076%, 0.164% and 0.065%, while the right side were 0.255%, 0.410%, 0.586% and 0.302% (P ＜0.05). The values for SER120 in group three, five and six were 0.221% , 0.158% and 0.059% for the left side, and 0.405%,0.522% and 0.207% for the right side(P ＜0.05). The values for MSER in group three, five and six were 0.217% ,0.164% and 0.072% for the left side, and 0.405%, 0.586% and 0.302% for the right side(P ＜0.05). Conclusion DCE-MRI technique may be useful in the diagnosis of testicular torsion, which shows potential in the clinical application.